常用外科手術(shù)器械及其使用

1、Copyright All reserved, MA WM PhD第六章 手術(shù)基本操作技術(shù)手術(shù)種類繁多，范圍、大小和復(fù)雜程度不同，但基本操作技術(shù)是相同的手術(shù)順利完成，一定意義上取決于基本操作的熟練程度及其理論的掌握理論指導(dǎo)下的不斷實踐，是唯一的正確途徑。穩(wěn)、準(zhǔn)、巧、輕、快是基本要求。Copyright All reserved, MA WM PhD內(nèi) 容 提 綱第一節(jié) 常用外科器械及其使用第二節(jié)顯露第三節(jié) 止血第四節(jié) 縫合第五節(jié) 拆線第六節(jié) 打結(jié)第七節(jié) 引流Copyright All reserved, MA WM PhD（一）種類4、6、8號刀柄配1924號刀片。3、5、7號刀柄配10、11

2、、12、15號刀片專用手術(shù)刀，如眼科刀等。高頻電刀。第一節(jié) 常用外科器械及其使用一、手術(shù)刀Copyright All reserved, MA WM PhDSharp scalpel with disposable10號小圓刃11號角形尖刃12號號彎形尖刃15號小圓刃3號刀柄8號刀柄Copyright All reserved, MA WM PhDHandlesCopyright All reserved, MA WM PhDHandles Blades Blades #10, 11, 12, 15 fit the #3 handle, #22, #23 fit the #4 handle ,

3、 commonly used for large animals. Copyright All reserved, MA WM PhDDisposable ScalpelCopyright All reserved, MA WM PhDElectrosurgical scalpelCopyright All reserved, MA WM PhD（二）手術(shù)刀的使用裝刀片法取刀片法視頻026Copyright All reserved, MA WM PhD裝刀片Copyright All reserved, MA WM PhDThree basic grips for holding the s

4、calpelPencil gripFingertip gripPalm gripCopyright All reserved, MA WM PhDScalpels Copyright All reserved, MA WM PhDThe scalpel is held with thumb, middle and ring finger while the index finger is placed on the upper edge to help guide the scalpel. Long gentle cutting strokes are less traumatic to ti

5、ssue than short chopping motions. Copyright All reserved, MA WM PhDThe scalpel should never be used in a stabbing motion Copyright All reserved, MA WM PhD二、 surgical scissors組織剪剪線剪Commonly used surgical scissorsCopyright All reserved, MA WM PhDClassification by type of pointsAll types of scissors ca

6、n have blunt or sharp blades (A: Sharp:Sharp, B: Blunt:Blunt). Copyright All reserved, MA WM PhDAll types can have either straight or curved blades Copyright All reserved, MA WM PhDMayo and Metzenbaum Copyright All reserved, MA WM PhDMayo scissors (B) are used for cutting heavy fascia and sutures. M

7、etzenbaum scissors (A) are more delicate than Mayo scissors. Metzenbaum scissors are used to cut delicate tissues and scissors have a longer handle to blade ratio.Copyright All reserved, MA WM PhD執(zhí)剪的方法剪線的方法視頻027 Copyright All reserved, MA WM PhD三、 tissue forcepsA.Different tissue forcepsB.Pencil gri

8、p for thumb forcep in useC.Palmed position for thumb forcep being carriedCopyright All reserved, MA WM PhDThumb forceps are held like a pencil Copyright All reserved, MA WM PhDThumb Forceps are not held like a knife Copyright All reserved, MA WM PhD鑷子在手術(shù)中的使用視頻028 Copyright All reserved, MA WM PhD四、止

9、血鉗五、持針鉗Hemostatic forcepsNeedle holderCopyright All reserved, MA WM PhD持針鉗在手術(shù)中的應(yīng)用Copyright All reserved, MA WM PhDClassification by size and shape and size of tipsHemostatic forceps and hemostats may be curved or straight. Copyright All reserved, MA WM PhDKelly Hemostatic Forceps and Mosquito Hemost

10、ats Both are transversely serrated Mosquito hemostats (A) are more delicate than Kelly hemostatic forceps (B). Copyright All reserved, MA WM PhDMosquito hemostats (A) have a smaller, finer tip Comparison of Kelly and Mosquito tips Copyright All reserved, MA WM PhDCarmalt 視頻029 Copyright All reserved

11、, MA WM PhDMayo-Hegar Heavy, with mildly tapered jaws. No cutting blades. Copyright All reserved, MA WM PhDOlsen-Hegar Includes both needle holding jaw and scissors blades. The disadvantage to having blades within the needle holder is the suture material may be accidentally cut.Copyright All reserve

12、d, MA WM PhD六、surgical needles1.needle point 2.needle body 3.needle length 4.needle diameter 5.needle chord length 6.needle ridusABCB.conventional cuttingC.reverse cuttingA.The shape of the point and body of nocuttingCopyright All reserved, MA WM PhD七、retractorRib retractorAbdominalPerinealCopyright

13、 All reserved, MA WM PhDSenn Blades at each end. Blades can be blunt (delicate) or sharp (more traumatic, used for fascia). Copyright All reserved, MA WM PhDHohmanLevers tissue away from bone during orthopedic procedures. Copyright All reserved, MA WM PhDWeitlaner Ends can be blunt or sharp. Has rak

14、e tips. Ratchet to hold tissue apart. Copyright All reserved, MA WM PhDGelpiHas single point tips. Ratchet to hold tissue apart. Copyright All reserved, MA WM PhD創(chuàng)鉤在手術(shù)中的應(yīng)用視頻030 Copyright All reserved, MA WM PhD創(chuàng)鉤的使用Copyright All reserved, MA WM PhD創(chuàng)鉤的使用Copyright All reserved, MA WM PhD創(chuàng)鉤的使用Copyright

15、 All reserved, MA WM PhD八、towel forcep視頻031 Copyright All reserved, MA WM PhD九、tissue forcepsCopyright All reserved, MA WM PhDForceps: consist of two tines held together at one end with a spring device that holds the tines open. Forceps can be either tissue or dressing forceps. Dressing forceps have

16、 smooth or smoothly serrated tips. Tissue forceps have teeth to grip tissue. Many forceps bear the name of the originator of the design, such as Adson tissue forceps.Copyright All reserved, MA WM PhDRat Tooth: A Tissue ForcepsInterdigitating teeth hold tissue without slipping. Used to hold skin/dens

17、e tissue Copyright All reserved, MA WM PhDAdson Tissue ForcepsSmall serrated teeth on edge of tips. The Adsons tissue forceps has delicate serrated tips designed for light, careful handling of tissue Copyright All reserved, MA WM PhDAllis: An Intestinal Tissue ForcepsInterdigitating short teeth to g

18、rasp and hold bowel or tissue. Slightly traumatic, use to hold intestine, fascia and skin Copyright All reserved, MA WM PhDBabcock: An Intestinal Tissue Forceps More delicate than Allis, less directly traumatic. Broad, flared ends with smooth tips. Used to atraumatically hold viscera (bowel and blad

19、der). Copyright All reserved, MA WM PhDSponge ForcepsSponge forceps can be straight or curved, can have smooth or serrated jaws. Used to atraumatically hold viscera (bowel and bladder). Copyright All reserved, MA WM PhD十、腸鉗Copyright All reserved, MA WM PhDDoyen Intestinal ForcepsNon-crushing intesti

20、nal occluding forceps with longitudinal serrations. Used to temporarily occlude lumen of bowel Copyright All reserved, MA WM PhDPayr Pylorus ClampsA crushing intestinal instrument. Used to occlude the end of bowel to be resected. Copyright All reserved, MA WM PhDThe thumb and ring finger are inserte

21、d into the rings of the scissors while the index and middle finger are used to guide the instrument. The instrument should remain at the tips of the fingers for maximum control. Copyright All reserved, MA WM PhDThis is the wrong way to hold the scissors. The ring finger should be inserted into the r

22、ing Copyright All reserved, MA WM PhDThis is also the wrong way to hold the scissors. The tips of the scissors should be pointing upwards Copyright All reserved, MA WM PhD十一、器械的傳遞手術(shù)剪的傳遞Copyright All reserved, MA WM PhD持針鉗的傳遞Copyright All reserved, MA WM PhDAn acceptable hand signal for a needle hold

23、er with suture An acceptable hand signal for thumb forcepCopyright All reserved, MA WM PhD.An acceptable signal for scalpelA. An acceptable hand signal for a hemostat返回Copyright All reserved, MA WM PhDA、B.Passing an instrument pack to a scrubbed member of the operating team ABC.An acceptable way of

24、changing positions during a surgical procedure C返回骨折與創(chuàng)傷的急救一、定義及概述創(chuàng)傷指各種物理，生物，化學(xué)因子造成的人體組織結(jié)構(gòu)連續(xù)性破壞，一般是外界機械性物質(zhì)接觸人體所造成。隨著現(xiàn)代工業(yè)、建筑業(yè)、交通運輸業(yè)等的迅速發(fā)展，嚴(yán)重創(chuàng)傷發(fā)生率日益增多，多發(fā)傷的比例也明顯上升。64創(chuàng)傷現(xiàn)場急救是指對傷員在醫(yī)院前的緊急救護(hù)。 目的是使用簡單而有效的方法搶救生命 保護(hù)患肢安全運送便于后續(xù)治療。 包括在受傷現(xiàn)場的救護(hù)及保健站、急救站的救護(hù)。分為：自救、互救和醫(yī)務(wù)人員的初次救護(hù)三類。創(chuàng)傷后的病理生理創(chuàng)傷性炎癥 源于組織斷裂.膠原纖維暴露和細(xì)胞破壞;臨床局部表現(xiàn)

25、為疼痛,腫脹,功能障礙.炎癥對組織修復(fù)起有利作用,但作用過于強烈或廣泛對機體又有不利影響.神經(jīng)內(nèi)分泌系統(tǒng)的反應(yīng) 創(chuàng)傷刺激,失血,失液,精神緊張等,可引起神經(jīng)-內(nèi)分泌方面的變化,特別是交感神經(jīng)-腎上腺髓質(zhì),下丘腦-垂體-腎上腺皮質(zhì)以及腎素-醛固酮的變化,進(jìn)而影響全身其他器官功能改變.代謝變化 創(chuàng)傷后體液,體內(nèi)能源,蛋白質(zhì),電解質(zhì)等都有相應(yīng)改變.免疫功能變化 引起中性粒細(xì)胞和單核細(xì)胞的變化.機械性創(chuàng)傷的分類閉合性創(chuàng)傷包括：挫傷、擠壓傷、扭傷、關(guān)節(jié)脫位和半脫位、骨折、閉合性內(nèi)部組織器官損傷等。 開放性創(chuàng)傷包括：擦傷、撕裂傷、刺傷、切傷、砍傷、火器傷等；檢查及診斷方法詢問病史 向傷者和了解情況者詳細(xì)詢

26、問致傷原因,作用部位,受傷姿勢(如對沖傷等)。傷后出現(xiàn)癥狀及演變過程(如顱腦損傷曾有中間清醒期），經(jīng)過處理及時間（如止血帶應(yīng)計算使用時間），既往病史與損傷相關(guān)的病史(如高血壓,糖尿病,肝硬化，尿毒癥等）。為此應(yīng)詳細(xì)了解創(chuàng)傷史確定其部位，性質(zhì)，程度，全身改變以及并發(fā)癥。體格檢查及現(xiàn)場處理首先觀察生命體征，意識狀態(tài)，面容體位。尤應(yīng)注意有無窒息，休克表現(xiàn)。情況危重者，立即搬到安全地帶現(xiàn)場搶救。詳細(xì)檢查傷處，依據(jù)傷勢及體征初步判定有無復(fù)合傷（如腹部應(yīng)檢查觸痛，腹肌緊張，反跳痛，移動性濁音，肝濁音區(qū)及腸鳴。開放性性損傷 應(yīng)認(rèn)真查看傷口或創(chuàng)面，注意形狀，出血，污染，滲出物及傷道位置等情況。輔助檢查 選擇必

27、要項目，減輕病原痛苦，避免時間，人力物力浪費。勿失搶救時機。檢查注意事項危重情況，立即搶救，爭取時間，生命第一，鎮(zhèn)定有序。檢查方法簡捷，動作謹(jǐn)慎輕巧，防止再損傷及醫(yī)源性損傷。重視癥狀明顯的部位，同時查找隱蔽損傷，不可忽視沉默傷員。傷情復(fù)雜，一時難以診斷者應(yīng)在對癥處理中嚴(yán)密觀察病情變化。急救的五個重要環(huán)節(jié)通氣 暢通呼吸道止血 保持循環(huán)穩(wěn)定包扎 創(chuàng)面清潔及保護(hù)固定 避免再損傷，緩解疼痛轉(zhuǎn)運 提供更好的治療創(chuàng)傷現(xiàn)場急救中應(yīng)注意的問題銳器刺傷 刺傷身體任何部位均不可將銳器拔出。應(yīng)將紗布繃帶等將銳器四周固定后包扎好后送醫(yī)院急救。如在現(xiàn)場將銳器拔出將導(dǎo)致出血不止而造成不可收拾的后果。顱腦損傷 禁止沖洗和填塞腦脊液流出道，應(yīng)將其側(cè)向一邊，任其流出，并不斷用干凈的干的消毒棉花或紗布將血液和腦脊液揩干凈。頸部傷 不能用繃帶纏繞頸項,如合并頸椎骨折的應(yīng)用頸椎外國定架固定或與身體保持一致的協(xié)調(diào)性滾動式翻身側(cè)臥定（以利于暢通氣道）。胸部傷 應(yīng)注意有無開放性氣胸。如有開放性氣胸急救時應(yīng)將傷口封住使其不再漏氣?？捎靡粡埓蟮乃芰霞垑鹤?，再用一個大的裹傷包或兩個急救包緊緊包扎，外面加用寬繃帶纏繞。腹部損傷 有腸管和大網(wǎng)膜脫出，包扎時不可還納，以免造成污染和再次損傷，也不利于觀察內(nèi)臟血運情況。四肢損傷 如有骨折，在運送之前應(yīng)用木