第六章 手术基本操作技术

2. 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。

3. 第一节 常用外科器械及其使用 一、手术刀 • （一）种类 • 4、6、8号刀柄配19~24号刀片。 • 3、5、7号刀柄配10、11、12、15号刀片 • 专用手术刀，如眼科刀等。 • 高频电刀。

4. 12号号弯形尖刃 10号小圆刃 15号小圆刃 11号角形尖刃 3号刀柄 8号刀柄 Sharp scalpel with disposable

5. Handles

6. Handles and Blades Blades #10, 11, 12, 15 fit the #3 handle, #22, #23 fit the #4 handle , commonly used for large animals.

7. Disposable Scalpel

8. 高频电刀 Electrosurgical scalpel

9. （二）手术刀的使用 取刀片法 装刀片法

10. 装刀片

11. Pencil grip Fingertip grip Palm grip Three basic grips for holding the scalpel

12. Scalpels

13. 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 cutting strokes are less traumatic to tissue than short chopping motions.

14. The scalpel should never be used in a "stabbing" motion

15. 二、surgical scissors 组织剪 剪线剪 Commonly used surgical scissors

16. Classification by type of points All types of scissors can have blunt or sharp blades (A: Sharp:Sharp, B: Blunt:Blunt).

17. All types can have either straight or curved blades

18. Mayo and Metzenbaum

19. Mayo scissors (B) 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.

20. 执剪的方法 剪线的方法

21. 三、tissue forceps A.Different tissue forceps B.Pencil grip for thumb forcep in use C.Palmed position for thumb forcep being carried

22. Thumb forceps are held like a pencil

23. Thumb Forceps are not held like a knife

24. 镊子在手术中的使用

25. Hemostatic forceps Needle holder 四、止血钳 五、持针钳

26. 持针钳在手术中的应用

27. Classification by size and shape and size of tips Hemostatic forceps and hemostats may be curved or straight.

28. Kelly Hemostatic Forceps and Mosquito Hemostats Both are transversely serrated Mosquito hemostats (A) are more delicate than Kelly hemostatic forceps (B).

29. Comparison of Kelly and Mosquito tips Mosquito hemostats (A) have a smaller, finer tip

30. Carmalt

31. Mayo-Hegar Heavy, with mildly tapered jaws. No cutting blades.

32. Includes both needle holding jaw and scissors blades. Olsen-Hegar The disadvantage to having blades within the needle holder is the suture material may be accidentally cut.

33. 六、surgical needles A.The shape of the point and body of nocutting A B C 1.needle point 2.needle body 3.needle length 4.needle diameter 5.needle chord length 6.needle ridus B.conventional cutting C.reverse cutting

34. 七、retractor Rib retractor Abdominal~ Perineal~

35. Senn Blades at each end. Blades can be blunt (delicate) or sharp (more traumatic, used for fascia).

36. Hohman Levers tissue away from bone during orthopedic procedures.

37. Weitlaner Ends can be blunt or sharp. Has rake tips. Ratchet to hold tissue apart.

38. Gelpi Has single point tips. Ratchet to hold tissue apart.

39. 创钩在手术中的应用

40. 创沟的使用

41. 创沟的使用

42. 创沟的使用

43. 八、towel forcep

44. 九、tissue forceps

45. Forceps: consist of two tines held together at one end with a spring 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.

46. Rat Tooth: A Tissue Forceps Interdigitating teeth hold tissue without slipping. Used to hold skin/dense tissue

47. Adson Tissue Forceps Small serrated teeth on edge of tips. The Adsons tissue forceps has delicate serrated tips designed for light, careful handling of tissue

48. Allis: An Intestinal Tissue Forceps Interdigitating short teeth to grasp and hold bowel or tissue. Slightly traumatic, use to hold intestine, fascia and skin

49. Babcock: An Intestinal Tissue Forceps More delicate that Allis, less directly traumatic. Broad, flared ends with smooth tips.Used to atraumatically hold viscera (bowel and bladder).

50. Sponge Forceps Sponge forceps can be straight or curved, can have smooth or serrated jaws. Used to atraumatically hold viscera (bowel and bladder).