手术室篇ppt课件.ppt

手术涉及的解剖结构 耳大神经、颈外静脉 颈阔肌、胸锁乳突肌 颈内静脉、面静脉 颈内动脉 颈总动脉 颈袢、舌下神经、迷走神经、喉上神经、面神经 颈阔肌 External jugular vein: vein is ligated and divided; Arteria branch of the great auricular nerve; Great auricular nerve（耳大神经） External jugular vein 颈动脉鞘 The jugular vein is not dissected free; it is merely identifi ed and left untouched. 触及CCA，分离方向：向头端，由CCA, ICA, ECA, superior thyroid arteries； 向上：Posterior belly of the digastric muscle（二腹肌）; 向下：Further exposure: Inferiorly the middle thyroid vein（甲状腺中静脉） may require ligation and the omohyoid muscle（肩胛舌骨肌）; 需耐心处理的：淋巴结 需注意的：观察心率，必要时应用局麻药物；不要急于升压提升心率 Posterior belly of the digastric muscle; Hypoglossal nerve 重要标记：The hypoglossal nerve: crosses the internal and external carotid arteries; 颈袢：Ansa cervicalis; 调整方向及深度：Self-retaining retractor； 此过程轻提血管外膜，分离过程尽量不触及分叉部或斑块处；减少斑块脱落的风险； 分离是为临时阻断做准备，不要过分游离血管； 鞘的固定：可起到提起血管的作用，利于操作； 特例：ECA、ICA并非平行，而是前后关系时，则需将分叉部尽可能分离； 肝素：Dose of 5000 units of heparin or 30 u/kg body weight of intravenous heparin; 阻断顺序： ----The first clip is applied to the ICA, then one each to the ECA and the superior thyroid artery and finally to the CCA.（试阻断） ----Clamps were applied sequentially to the superior thyroid artery, the common carotid artery, internal carotid artery, and the external carotid artery.（持续阻断） ----返血：分别提起ECA，ICA阻断带；或源于咽升A，使用较大的阻断夹完全阻断ECA； 重要标记：The hypoglossal nerve: crosses the internal and external carotid arteries; 颈袢：Ansa cervicalis; 调整方向及深度：Self-retaining retractor； 此过程轻提血管外膜，分离过程尽量不触及分叉部或斑块处；减少斑块脱落的风险； 分离是为临时阻断做准备，不要过分游离血管； 鞘的固定：可起到提起血管的作用，利于操作； 特例：ECA、ICA并非平行，而是前后关系时，则需将分叉部尽可能分离； 动脉切开：longitudinal arteriotomy注意刀片方向：Cutting edge outwards so that once the lumen is entered, the blade can be drawn outwards to commence a longitudinal arteriotomy. 技巧：切开动脉壁时：可标记切口，以确保方向； The arteriotomy is slightly lateral to the midline (from the surgeon’s point of vision); especially at the bifurcation it runs some 3 mm lateral from the upper aspect of the bifurcation; Potts angle scissors 近端: the vessel is palpated to find a