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1、Copyright All reserved,MA WM PhD内内 容容 提提 纲纲 第一节第一节 常用外科器械及其使用常用外科器械及其使用 第二节显露第二节显露 第三节第三节 止血止血 第四节第四节 缝合缝合 第五节第五节 拆线拆线 第六节第六节 打结打结 第七节第七节 引流引流第1页/共61页Copyright All reserved,MA WM PhD（一）种类4 4、6 6、8 8号刀柄配号刀柄配19192424号刀片。号刀片。3 3、5 5、7 7号刀柄配号刀柄配1010、1111、1212、1515号刀片号刀片专用手术刀，如眼科刀等。专用手术刀，如眼科刀等。高频电刀。高频电刀。
2、第一节 常用外科器械及其使用一、手术刀第2页/共61页Copyright All reserved,MA WM PhDSharp scalpel with disposable1 10 0号号小小圆圆刃刃1 11 1号号角角形形尖尖刃刃1 12 2号号号号弯弯形形尖尖刃刃1 15 5号号小小圆圆刃刃3 3号刀柄号刀柄8 8号刀柄号刀柄第3页/共61页Copyright All reserved,MA WM PhDHandles第4页/共61页Copyright All reserved,MA WM PhDHandles Blades Blades#10,11,12,15 fit the#3 h
3、andle,#22,Blades#10,11,12,15 fit the#3 handle,#22,#23 fit the#4 handle,commonly used for#23 fit the#4 handle,commonly used for large animals.large animals.第5页/共61页Copyright All reserved,MA WM PhDDisposable Scalpel第6页/共61页Copyright All reserved,MA WM PhDElectrosurgical scalpel第7页/共61页Copyright All re
4、served,MA WM PhD（二）手术刀的使用装刀片法取刀片法视频026第8页/共61页Copyright All reserved,MA WM PhD装刀片第9页/共61页Copyright All reserved,MA WM PhDThree basic grips for holding the scalpelPencil gripFingertip gripPalm grip第10页/共61页Copyright All reserved,MA WM PhDScalpels 第11页/共61页Copyright All reserved,MA WM PhDThe scalpel i
5、s 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 tissue than short chopping motions.第12页/共61页Copyright All reserved,MA WM PhDThe scalpel should never be used in a stabbing motion Th
6、e scalpel should never be used in a stabbing motion 第13页/共61页Copyright All reserved,MA WM PhD二、surgical scissors组织剪剪线剪Commonly used surgical scissors第14页/共61页Copyright All reserved,MA WM PhDClassification by type of pointsAll types of scissors can have blunt or sharp blades(A:Sharp:Sharp,B:Blunt:Blu
7、nt).第15页/共61页Copyright All reserved,MA WM PhDAll types can have either straight or curved blades 第16页/共61页Copyright All reserved,MA WM PhDMayo and Metzenbaum 第17页/共61页Copyright All reserved,MA WM PhDMayo scissors(B)are used for cutting heavy fascia and sutures.Metzenbaum scissors(A)are more delicate
8、 than Mayo scissors.Metzenbaum scissors are used to cut delicate tissues and scissors have a longer handle to blade ratio.第18页/共61页Copyright All reserved,MA WM PhD执剪的方法剪线的方法视频027 第19页/共61页Copyright All reserved,MA WM PhD三、tissue forcepsA.Different tissue forcepsB.Pencil grip for thumb forcep in useC
9、.Palmed position for thumb forcep being carried第20页/共61页Copyright All reserved,MA WM PhDThumb forceps are held like a pencil 第21页/共61页Copyright All reserved,MA WM PhDThumb Forceps are not held like a knife 第22页/共61页Copyright All reserved,MA WM PhD镊子在手术中的使用视频028 第23页/共61页Copyright All reserved,MA WM
10、PhD四、止血钳五、持针钳Hemostatic forcepsNeedle holder第24页/共61页Copyright All reserved,MA WM PhD持针钳在手术中的应用第25页/共61页Copyright All reserved,MA WM PhDClassification by size and shape and size of tipsHemostatic forceps and hemostats may be curved or straight.第26页/共61页Copyright All reserved,MA WM PhDKelly Hemostati
11、c Forceps and Mosquito Hemostats Kelly Hemostatic Forceps and Mosquito Hemostats Both are transversely serrated Both are transversely serrated Mosquito hemostats(A)are more Mosquito hemostats(A)are more delicate than Kelly hemostatic delicate than Kelly hemostatic forceps(B).forceps(B).第27页/共61页Copy
12、right All reserved,MA WM PhDMosquito hemostats(A)have a smaller,finer tip Comparison of Kelly and Mosquito tips 第28页/共61页Copyright All reserved,MA WM PhDCarmalt 视频029 第29页/共61页Copyright All reserved,MA WM PhDMayo-Hegar Heavy,with mildly tapered jaws.No cutting Heavy,with mildly tapered jaws.No cutti
13、ng blades.blades.第30页/共61页Copyright All reserved,MA WM PhDOlsen-Hegar Includes both needle holding jaw and scissors blades.Includes both needle holding jaw and scissors blades.The disadvantage to having blades within the The disadvantage to having blades within the needle holder is the suture materi
14、al may be needle holder is the suture material may be accidentally cut.accidentally cut.第31页/共61页Copyright All reserved,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 cuttingB.conventional cuttingC.rever
15、se cuttingC.reverse cuttingA.The shape of the point and A.The shape of the point and body of nocuttingbody of nocutting第32页/共61页Copyright All reserved,MA WM PhD七、retractorRib retractorRib retractorAbdominalAbdominalPerinealPerineal第33页/共61页Copyright All reserved,MA WM PhDSenn Blades at each end.Blad
16、es at each end.Blades can be blunt Blades can be blunt(delicate)(delicate)or sharp(more traumatic,used or sharp(more traumatic,used for fascia).for fascia).第34页/共61页Copyright All reserved,MA WM PhDHohmanLevers tissue away from bone during orthopedic procedures.第35页/共61页Copyright All reserved,MA WM P
17、hDWeitlaner Ends can be blunt or sharp.Has rake tips.Ratchet to hold tissue apart.第36页/共61页Copyright All reserved,MA WM PhDGelpiHas single point tips.Ratchet to hold tissue Has single point tips.Ratchet to hold tissue apart.apart.第37页/共61页Copyright All reserved,MA WM PhD创钩在手术中的应用视频030 第38页/共61页Copyr
18、ight All reserved,MA WM PhD创钩的使用第39页/共61页Copyright All reserved,MA WM PhD创钩的使用第40页/共61页Copyright All reserved,MA WM PhD创钩的使用第41页/共61页Copyright All reserved,MA WM PhD八、towel forcep视频031 第42页/共61页Copyright All reserved,MA WM PhD九、tissue forceps第43页/共61页Copyright All reserved,MA WM PhDForceps:Forceps:c
19、onsist consist of of two two tines tines held held together together at at one one end end with with a a spring spring device device that that holds holds the the tines tines open.open.Forceps Forceps can can be be either either tissue tissue or or dressing dressing forceps.forceps.Dressing forceps
20、have smooth or smoothly serrated tips.Dressing forceps have smooth or smoothly serrated tips.Tissue Tissue forceps forceps have have teeth teeth to to grip grip tissue.tissue.Many Many forceps forceps bear bear the the name name of of the originator of the design,such as Adson tissue forceps.the ori
21、ginator of the design,such as Adson tissue forceps.第44页/共61页Copyright All reserved,MA WM PhDRat Tooth:A Tissue ForcepsInterdigitating teeth hold tissue without slipping.Used to hold skin/dense tissue 第45页/共61页Copyright All reserved,MA WM PhDAdson Tissue ForcepsSmall serrated teeth on edge of tips.Th
22、e Adsons tissue forceps has delicate serrated tips designed for light,careful handling of tissue 第46页/共61页Copyright All reserved,MA WM PhDAllis:An Intestinal Tissue ForcepsInterdigitating short teeth to grasp and hold bowel or tissue.Slightly traumatic,use to hold intestine,fascia and skin 第47页/共61页
23、Copyright All reserved,MA WM PhDBabcock:An Intestinal Tissue Forceps More More delicate delicate than than Allis,Allis,less less directly directly traumatic.traumatic.Broad,Broad,flared flared ends ends with with smooth smooth tips.tips.Used Used to to atraumatically atraumatically hold hold viscera
24、 viscera(bowel(bowel and and bladder).bladder).第48页/共61页Copyright All reserved,MA WM PhDSponge ForcepsSponge forceps can be straight or curved,Sponge forceps can be straight or curved,can have smooth or serrated jaws.Used to can have smooth or serrated jaws.Used to atraumatically hold viscera(bowel
25、and atraumatically hold viscera(bowel and bladder).bladder).第49页/共61页Copyright All reserved,MA WM PhD十、肠钳第50页/共61页Copyright All reserved,MA WM PhDDoyen Intestinal ForcepsNon-crushing Non-crushing intestinal intestinal occluding occluding forceps forceps with with longitudinal longitudinal serrations
26、.serrations.Used Used to to temporarily temporarily occlude occlude lumen lumen of of bowel bowel 第51页/共61页Copyright All reserved,MA WM PhDPayr Pylorus ClampsA crushing intestinal instrument.Used to occlude the end of bowel to be resected.第52页/共61页Copyright All reserved,MA WM PhDThe The thumb thumb
27、and and ring ring finger finger are are inserted inserted into into the the rings rings of of the the scissors scissors while while the the index index and and middle middle finger finger are are used used to to guide guide the the instrument.instrument.The The instrument instrument should should re
28、main remain at at the the tips tips of of the the fingers fingers for for maximum maximum control.control.第53页/共61页Copyright All reserved,MA WM PhDThis is the This is the wrong waywrong way to hold the to hold the scissors.The ring finger should be scissors.The ring finger should be inserted into th
29、e ring inserted into the ring 第54页/共61页Copyright All reserved,MA WM PhDThis is also the This is also the wrong waywrong way to hold the to hold the scissors.The tips of the scissors should be scissors.The tips of the scissors should be pointing upwards pointing upwards 第55页/共61页Copyright All reserve
30、d,MA WM PhD十一、器械的传递手术剪的传递第56页/共61页Copyright All reserved,MA WM PhD持针钳的传递第57页/共61页Copyright All reserved,MA WM PhDAn acceptable hand signal for a needle holder with suture An acceptable hand signal for thumb forcep第58页/共61页Copyright All reserved,MA WM PhD.An acceptable signal for scalpelA.An acceptab
31、le hand signal for a hemostat返回第59页/共61页Copyright All reserved,MA WM PhDA A、B.Passing an B.Passing an instrument pack to a instrument pack to a scrubbed member of the scrubbed member of the operating teamoperating team ABC.An acceptable way of C.An acceptable way of changing positions changing positions during a surgical during a surgical procedureprocedure C返回第60页/共61页Copyright All reserved,MA WM PhD感谢您的观看！第61页/共61页