1、Copyright All reserved, MA WM PhD,第六章 手术基本操作技术,手术种类繁多，范围、大小和复杂程度不同，但基本操作技术是相同的手术顺利完成，一定意义上取决于基本操作的熟练程度及其理论的掌握理论指导下的不断实践，是唯一的正确途径。稳、准、巧、轻、快是基本要求。,Copyright All reserved, MA WM PhD,内 容 提 纲,第一节 常用外科器械及其使用第二节显露第三节 止血第四节 缝合第五节 拆线第六节 打结第七节 引流,Copyright All reserved, MA WM PhD,（一）种类4、6、8号刀柄配1924号刀片。3、5、7号刀
2、柄配10、11、12、15号刀片专用手术刀，如眼科刀等。高频电刀。,第一节 常用外科器械及其使用,一、手术刀,Copyright All reserved, MA WM PhD,Sharp scalpel with disposable,10号小圆刃,11号角形尖刃,12号号弯形尖刃,15号小圆刃,3号刀柄,8号刀柄,Copyright All reserved, MA WM PhD,Handles,Copyright All reserved, MA WM PhD,Handles Blades,Blades #10, 11, 12, 15 fit the #3 handle, #22, #2
3、3 fit the #4 handle , commonly used for large animals.,Copyright All reserved, MA WM PhD,Disposable Scalpel,Copyright All reserved, MA WM PhD,Electrosurgical scalpel,Copyright All reserved, MA WM PhD,（二）手术刀的使用,装刀片法,取刀片法,视频026,Copyright All reserved, MA WM PhD,装刀片,Copyright All reserved, MA WM PhD,Th
4、ree basic grips for holding the scalpel,Pencil grip,Fingertip grip,Palm grip,Copyright All reserved, MA WM PhD,Scalpels,Copyright All reserved, MA WM PhD,The 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 c
5、utting strokes are less traumatic to tissue than short chopping motions.,Copyright All reserved, MA WM PhD,The scalpel should never be used in a stabbing motion,Copyright All reserved, MA WM PhD,二、 surgical scissors,组织剪,剪线剪,Commonly used surgical scissors,Copyright All reserved, MA WM PhD,Classifica
6、tion by type of points,All types of scissors can have blunt or sharp blades (A: Sharp:Sharp, B: Blunt:Blunt).,Copyright All reserved, MA WM PhD,All types can have either straight or curved blades,Copyright All reserved, MA WM PhD,Mayo and Metzenbaum,Copyright All reserved, MA WM PhD,Mayo scissors (B
7、) are used for cutting heavy fascia and sutures. Metzenbaum 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,执剪的方法,剪线的方法,视频027,Copyright All reserved, MA WM PhD,
8、三、 tissue forceps,A.Different tissue forcepsB.Pencil grip for thumb forcep in useC.Palmed position for thumb forcep being carried,Copyright All reserved, MA WM PhD,Thumb forceps are held like a pencil,Copyright All reserved, MA WM PhD,Thumb Forceps are not held like a knife,Copyright All reserved, M
9、A WM PhD,镊子在手术中的使用,视频028,Copyright All reserved, MA WM PhD,四、止血钳,五、持针钳,Hemostatic forceps,Needle holder,Copyright All reserved, MA WM PhD,持针钳在手术中的应用,Copyright All reserved, MA WM PhD,Classification by size and shape and size of tips,Hemostatic forceps and hemostats may be curved or straight.,Copyrig
10、ht All reserved, MA WM PhD,Kelly Hemostatic Forceps and Mosquito Hemostats,Both are transversely serrated,Mosquito hemostats (A) are more delicate than Kelly hemostatic forceps (B).,Copyright All reserved, MA WM PhD,Mosquito hemostats (A) have a smaller, finer tip,Comparison of Kelly and Mosquito ti
11、ps,Copyright All reserved, MA WM PhD,Carmalt,视频029,Copyright All reserved, MA WM PhD,Mayo-Hegar,Heavy, with mildly tapered jaws. No cutting blades.,Copyright All reserved, MA WM PhD,Olsen-Hegar,Includes both needle holding jaw and scissors blades.,The disadvantage to having blades within the needle
12、holder is the suture material may be accidentally cut.,Copyright All reserved, MA WM PhD,六、surgical needles,1.needle point 2.needle body 3.needle length 4.needle diameter 5.needle chord length 6.needle ridus,A,B,C,B.conventional cuttingC.reverse cutting,A.The shape of the point and body of nocutting
13、,Copyright All reserved, MA WM PhD,七、retractor,Rib retractor,Abdominal,Perineal,Copyright All reserved, MA WM PhD,Senn,Blades at each end. Blades can be blunt (delicate) or sharp (more traumatic, used for fascia).,Copyright All reserved, MA WM PhD,Hohman,Levers tissue away from bone during orthopedi
14、c procedures.,Copyright All reserved, MA WM PhD,Weitlaner,Ends can be blunt or sharp. Has rake tips. Ratchet to hold tissue apart.,Copyright All reserved, MA WM PhD,Gelpi,Has single point tips. Ratchet to hold tissue apart.,Copyright All reserved, MA WM PhD,创钩在手术中的应用,视频030,Copyright All reserved, MA
15、 WM PhD,创钩的使用,Copyright All reserved, MA WM PhD,创钩的使用,Copyright All reserved, MA WM PhD,创钩的使用,Copyright All reserved, MA WM PhD,八、towel forcep,视频031,Copyright All reserved, MA WM PhD,九、tissue forceps,Copyright All reserved, MA WM PhD,Forceps: consist of two tines held together at one end with a spri
16、ng device that holds the tines open. Forceps can be either tissue or dressing forceps. Dressing forceps have 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, M
17、A WM PhD,Rat Tooth: A Tissue Forceps,Interdigitating teeth hold tissue without slipping. Used to hold skin/dense tissue,Copyright All reserved, MA WM PhD,Adson Tissue Forceps,Small serrated teeth on edge of tips. The Adsons tissue forceps has delicate serrated tips designed for light, careful handli
18、ng of tissue,Copyright All reserved, MA WM PhD,Allis: An Intestinal Tissue Forceps,Interdigitating short teeth to grasp and hold bowel or tissue. Slightly traumatic, use to hold intestine, fascia and skin,Copyright All reserved, MA WM PhD,Babcock: An Intestinal Tissue Forceps,More delicate than Alli
19、s, less directly traumatic. Broad, flared ends with smooth tips. Used to atraumatically hold viscera (bowel and bladder).,Copyright All reserved, MA WM PhD,Sponge Forceps,Sponge forceps can be straight or curved, can have smooth or serrated jaws. Used to atraumatically hold viscera (bowel and bladde
20、r).,Copyright All reserved, MA WM PhD,十、肠钳,Copyright All reserved, MA WM PhD,Doyen Intestinal Forceps,Non-crushing intestinal occluding forceps with longitudinal serrations. Used to temporarily occlude lumen of bowel,Copyright All reserved, MA WM PhD,Payr Pylorus Clamps,A crushing intestinal instrum
21、ent. Used to occlude the end of bowel to be resected.,Copyright All reserved, MA WM PhD,The thumb and ring finger are inserted 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 contro
22、l.,Copyright All reserved, MA WM PhD,This is the wrong way to hold the scissors. The ring finger should be inserted into the ring,Copyright All reserved, MA WM PhD,This 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
23、一、器械的传递,手术剪的传递,Copyright All reserved, MA WM PhD,持针钳的传递,Copyright All reserved, MA WM PhD,An acceptable hand signal for a needle holder with suture,An acceptable hand signal for thumb forcep,Copyright All reserved, MA WM PhD,.An acceptable signal for scalpel,A,. An acceptable hand signal for a hemostat,返回,Copyright All reserved, MA WM PhD,A、B.Passing an instrument pack to a scrubbed member of the operating team,A,B,C.An acceptable way of changing positions during a surgical procedure,C,返回,
