显微外科技术的基础训练.pptx

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,,*,一.显微镜下手术特点,清楚，放大，立体感,视野小，景深短，易抖动，眼肌调整难,2020/11/3,1,,二、显微外科技术的训练要求,轻柔，稳健，移动幅度小,避免上下移动，学会平移,在镜下训练切开，分离，缝合，打结,2020/11/3,2,,显微外科技术训练要求,眼睛不离开目镜，完成一个吻合口,训练眼睛离开和返回目镜架的适应能力,主刀和助手的协同动作,2020/11/3,3,,三、血管的缝接方法,端端吻合,端侧吻合,盘端吻合,盘侧吻合,侧侧吻合,相嵌吻合,,2020/11/3,4,,一、血管的端端吻合,剥离外膜,距端端5mm,扩张血管,液压扩张或机械扩张,修整血管端,用两定点或三定点吻合法,2020/11/3,5,,2020/11/3,6,,2020/11/3,7,,2020/11/3,8,,2020/11/3,9,,2020/11/3,10,,2020/11/3,11,,2020/11/3,12,,血管缝接的注意事项,边距与针距,边距过大 血管壁内翻，吻合口狭窄,边距过小 血管壁撕裂,2020/11/3,13,,血管缝接的注意事项,边距与间距,边距 血管壁的1～2倍,针距 边距的2倍,直径2mm血管 12针,2020/11/3,14,,2020/11/3,15,,血管缝接的注意事项,进针：垂直进针,出针：顺针的弧度拔针,,2020/11/3,16,,2020/11/3,17,,2020/11/3,18,,血管缝接的注意事项,口径不等时的血管缝接,将较小的一侧血管剪成斜面,侧面口径＝较大的血管口径,2020/11/3,19,,2020/11/3,20,,血管缝接的注意事项,口径不等的血管缝接,将较小的一侧血管剪开一个缺口，,充分利用有缺口的斜面,2020/11/3,21,,2020/11/3,22,,缝接血管的注意事项,湿操作，防止创面干燥,2020/11/3,23,,五、 检查血管缝接质量,血管通畅试验,漏水试验,切下吻合口，镜下检查,,2020/11/3,24,,2020/11/3,25,,二、血管的端侧吻合,,适应证,：,两血管口径相差太大,主要血管不能切断,2020/11/3,26,,端侧缝接的注意事项,偏斜角30－60度为宜，血流方向一致,端侧血管剪成斜面,侧方切口略大于端侧口径,2020/11/3,27,,2020/11/3,28,,2020/11/3,29,,端侧缝接的注意事项,褥式：四定点缝接法,,其余缝线用连续式或间断缝接法,2020/11/3,30,,三、盘侧吻合,适应证,两血管外径相差太悬殊,如1cm对1mm直径,2020/11/3,31,,盘侧吻合,盘的制作,分支成盘,侧壁成盘,2020/11/3,32,,2020/11/3,33,,2020/11/3,34,,四、盘端吻合,同盘侧吻合,2020/11/3,35,,五、镶嵌吻合,适应证,两血管外径相差太悬殊,方法同端端吻合,2020/11/3,36,,2020/11/3,37,,显微外科技术的基本训练,在显微镜下切开，缝合橡皮片,,练习进针，拔针，打结，剪线,2020/11/3,38,,六、血管的侧侧缝接,门腔静脉的侧侧缝接,,肠系膜上静脉与腔静脉侧侧缝接,2020/11/3,39,,2020/11/3,40,,2020/11/3,41,,周围神经的缝接技术训练,修复断离的周围神经最重要的环节,,良好的对合,2020/11/3,42,,周围神经的缝接方法,外膜缝接法,束膜缝接法,联合缝接法,2020/11/3,43,,外膜缝接法,用快刀切断神经或逐渐切断神经瘤至正常部位,间断缝合外膜,要求:外膜不内翻,神经束不外露,,,,2020/11/3,44,,2020/11/3,45,,束膜缝接法,切除两神经断端外膜,将相应的神经束或束组搭配,每束缝1-2针,大束缝3针,2020/11/3,46,,2020/11/3,47,,联合缝接法,切断神经同外膜,,缝接外膜与相邻的束膜,2020/11/3,48,,2020/11/3,49,,外膜,疏松的结缔组织,束膜,坚韧的结缔组织,2020/11/3,50,,束膜缝接法,优点：缝合牢固、可靠，神经束 对合良好,缺点：缝接困难，神经内留下大 量缝线线结。

2020/11/3,51,,外膜缝接法,优点:简单快速,神经内无缝线,缺点:不牢,束与束分离或束穿出外膜外,2020/11/3,52,,联合缝合法,结合前两者的优点,排除前两者的缺点,2020/11/3,53,,精湛的外科技术,是外科医师成功的关键,训练显微外科技术是外科医师走向成功的道路,,2020/11/3,54,,,,.,2020/11/3,55,,大鼠血管缝合的技术操作,2020/11/3,56,,股动脉缝合法,1.麻醉,2.将大鼠仰卧位，四肢分开，固定于木板上3.腹股沟处脱毛和消毒4.在股内侧作一纵行皮肤切口，上端始自腹股沟韧带中点，下至股骨内髁近端，暴露股动脉2020/11/3,57,,2020/11/3,58,,5.游离股动脉后上血管夹，切断血管，用普鲁卡因肝素溶液冲洗血管断端6.按前述原则和方法缝合血管7.缝合完后，先撤去远端血管夹再撤区近端血管夹，缝合静脉则相反8.检查吻合口通畅情况，并用湿盐水纱布湿敷止血2020/11/3,59,,--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------,2020/11/3,60,,颈动脉缝合法,2020/11/3,61,,2020/11/3,62,,2020/11/3,63,,。