二十、眼部手术.ppt

三、眼部手术（一）眼睑内翻矫正术（一）眼睑内翻矫正术【【适应症适应症】】下眼睑内翻下眼睑内翻 【【保定和麻醉保定和麻醉】】俯卧保定，全身俯卧保定，全身 麻醉麻醉或浸润麻醉或浸润麻醉 BlepharospasmBlepharospasmInturningInturningExcoriationExcoriationPurulent Purulent dischargedischargeSecondary Secondary uveitisuveitis and and hypopyonhypopyon if if lesion is severelesion is severeSevere conjunctivitisSevere conjunctivitisedemaedemaulcerationulcerationblepharospasmblepharospasmMiosisMiosis（（especially if the especially if the cornea is ulceratedcornea is ulcerated））epiphoraepiphoraepiphoraepiphoraDermis hydratedDermis hydratedinturninginturning用用镊子镊子距睑缘距睑缘2~4mm2~4mm提起皮肤，并用直止血提起皮肤，并用直止血 钳或弯钳或弯止血钳止血钳将其夹住将其夹住【【术式术式】】钳夹长度与内翻睑缘相等，宽度依内翻程度而钳夹长度与内翻睑缘相等，宽度依内翻程度而 定定( (钳夹时眼睑应有一定程度的外翻钳夹时眼睑应有一定程度的外翻) )。

用力钳压皮肤或用持针钳钳压止血钳用力钳压皮肤或用持针钳钳压止血钳 ，使去除止血钳后皮肤仍皱起，使去除止血钳后皮肤仍皱起沿止血钳压痕将其剪除沿止血钳压痕将其剪除皮肤切口呈月牙形或椭圆形皮肤切口呈月牙形或椭圆形用用4 4号丝线结节缝合皮肤创缘缝合号丝线结节缝合皮肤创缘缝合 要密，保持针距要密，保持针距2mm2mm术后护理】Ø患眼涂布或滴入抗生素眼膏或抗生素眼药水，3~4次/dØ颈部安装颈圈，防止自我损伤病眼Ø术后10~14d拆线Ø术后数日局部肿胀可逐渐减轻（二）（二）眼睑外翻矫正术眼睑外翻矫正术 【【适应症适应症】】下眼睑外翻下眼睑外翻保定和麻醉保定和麻醉】】俯卧保定，全俯卧保定，全麻或浸润麻醉麻或浸润麻醉【【术式一术式一】】outturningoutturningOutturned lidOutturned lidepiphoraepiphoraConjunctivalConjunctival congestion congestion and and inflammationinflammation 距睑外距睑外 翻下缘翻下缘 2~3mm2~3mm 处切一处切一 “ “V”V”形形 切口切口从其尖端向从其尖端向 上分离皮瓣上分离皮瓣 ，用镊子将，用镊子将 皮瓣提起，皮瓣提起， 再用剪刀钝再用剪刀钝 性分离性分离 ““V”V”形皮形皮 肤切口周围肤切口周围 皮下组织皮下组织从尖端向从尖端向 上作上作““Y”Y” 形缝合。

形缝合 边缝合边边缝合边 向上移动向上移动 皮瓣，直皮瓣，直 至外翻矫至外翻矫 正为止矫矫 正正 后后 的的 下下 眼眼 睑睑【【术式二术式二】】The lid The lid margin margin is is marked marked laterallylaterallyModified procedureModified procedureAn estimate of the amount of margin to be An estimate of the amount of margin to be removed is maderemoved is made，，and the lid is and the lid is marked.Themarked.The ventral end of the triangle is marked ventral end of the triangle is marked 10to14mm below. 10to14mm below. The The first first incision incision is is made made with with straight straight Mayo Mayo scissorsscissorsThe second incision is made The second incision is made The triangular The triangular piece is piece is removed.removed.Note that the Note that the conjunctivalconjunctival defect is smallerdefect is smaller ，，justifying one justifying one layer of sutures layer of sutures in the skin in in the skin in some cases.some cases. The wound sutured with 6~0 silk.The wound sutured with 6~0 silk.【术后护理】Ø患眼涂布或滴入抗生素眼膏或抗生素眼药水，3~4次/d。

Ø颈部安装颈圈，防止自我损伤病眼Ø术后10~14d拆线Ø术后数日内局部肿胀可逐渐减轻（三）第三眼睑腺摘除和复位术（三）第三眼睑腺摘除和复位术【【适应症适应症】】第三眼睑腺脱出（樱桃眼）第三眼睑腺脱出（樱桃眼）【【保定和麻醉保定和麻醉】】侧卧或胸侧卧保定全身侧卧或胸侧卧保定全身麻醉，先以麻醉，先以噻胺酮噻胺酮复合麻醉剂做复合麻醉剂做浅麻醉浅麻醉，，再以加有青霉素液的注射用水再以加有青霉素液的注射用水( (每每l0mll0ml加加青霉素青霉素1010万万IUIU) )冲洗眼结膜冲洗眼结膜，，然后滴入加然后滴入加有肾上腺素的有肾上腺素的局部麻醉剂局部麻醉剂局部解剖局部解剖】】位于瞬膜的前下方，被覆位于瞬膜的前下方，被覆脂肪组织腺体组织分泌的液体经多个脂肪组织腺体组织分泌的液体经多个 导管抵至球结膜表面，提供大约导管抵至球结膜表面，提供大约3030％的％的 水性泪膜水性泪膜 具有保护角膜、除去角膜上异物、分泌具有保护角膜、除去角膜上异物、分泌 和驱散角膜泪膜及免疫等功能和驱散角膜泪膜及免疫等功能 有作者认为不宜切除第三眼睑腺有作者认为不宜切除第三眼睑腺( (除非组除非组 织学证实为恶性肿瘤或严重损伤织学证实为恶性肿瘤或严重损伤) )，易引，易引 起角膜结膜炎和干性角膜结膜炎。

起角膜结膜炎和干性角膜结膜炎 【【术式术式】】1. 1.用组织钳夹住增生物包膜外用组织钳夹住增生物包膜外 引使充分暴露引使充分暴露2. 2.以小型弯止血钳钳夹蒂部以小型弯止血钳钳夹蒂部3. 3.以剪刀或外科刀剪除或切除以剪刀或外科刀剪除或切除4.尽量不损伤结膜及瞬膜，用青霉素液冲洗创口，3~5min后去除夹钳，灭菌干棉球压迫局部止血也可剪除增生物后立即烧烙止血，但要用湿灭菌纱布保护眼球，以免灼伤5.以青霉素40万IU肌注抗感染术后也可用新霉素眼药水点眼2~3d四） Excision of Eyelid TumorsØEyelid tumors are common in the dog.ØThe tarsal gland adenoma is the most frequently diagnosed eyelid tumor in the dog.ØLess commonly found areadenocarcinomas,melanomas， and papillomas.ØThe tarsal gland adenoma, as with most tumors of the canine eyelid,is clinically benign,and surgical excision is usually curative. ØCryosurgery using 1iquid nitrogen at -20℃ can also be used to treat these tumors.【【surgical methodsurgical method】】As the conjunctiva is not involved, it isnot removed. Incisions are outlined by dotted lines. The incisions are marked on the patient with a plastic surgerymarking pen. The vertical sides of the triangles are 20 per cent longer than the vertical incisions adjacent to the tumor to allow for wound contraction.ØA square or rectangular incision is made around the tumor. The tumor is dissected off from the base toward the lid margin.ØThe tumor is removed and placed in fixative,and is pinned to a piece of cardboard to allow the ophthalmic pathologist to examine the margins for evidence of tumor. Ø Note：If tumor is present in any margin, excision has been incomplete. The previously marked triangle is elevated and excised. The triangles have been removed The triangles have been removed and all incisions completed.and all incisions completed.ØTo prevent tension on the wound, the tissues surrounding the triangles and the flap are undermined. The flap is advanced to the margin with no tension on it.ØSimple marginal sutures of 6- 0 silk are placed. Sutures are placed at the corners of the incision to assist in accurate placement of subsequent sutures.ØRemaining sutures in place 2 mm apart. If the conjunctiva is mobile it is sutured to the skin edge,filling the defect with a simple continuous suture. T。