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Lapar o tomy

Lapar o tomy. B-2 김우진. Celiotomy & laparotomy. Celiotomy : 복강을 절개하는 것 Laparotomy : flank 를 절개하는 것 엄밀히 말하면 다른 말이지만 서로 비슷한 개념으로 사용. Anatomy. Transverse fascia. visceral peritoneum. peritoneal cavity. Peritoneum ( mesotelium ). perietal peritoneum. Anatomy. Anatomy.

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Lapar o tomy

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  1. Laparotomy B-2 김우진

  2. Celiotomy & laparotomy • Celiotomy: 복강을절개하는 것 • Laparotomy: flank를절개하는 것 엄밀히 말하면 다른 말이지만 서로 비슷한 개념으로 사용

  3. Anatomy Transverse fascia visceral peritoneum peritoneal cavity Peritoneum(mesotelium) perietal peritoneum

  4. Anatomy

  5. Anatomy

  6. Celiotomy • Ventral midline approach • Paramedian approach • Flank approach • Paracoastal approach

  7. Ventral midline approach • 전체복강:xiphoidprocess~pubis • Caudal incision: umbilicus~pubis, 방광 • Cranial incision: xiphoid~umbilicus, 간, 위 • Xiphoid에서 lateral extension:간, 담관계, 횡경막 • Paracostal,paralumbarceliotomy: 신장, 부신

  8. Ventral midline approach • Dorsal recumbency • 털은 흉골 중간부터 회음부까지, 넓이는 costal arch의 1/3정도 • 수컷의 prepuce는 타올클램프를 이용Preputialopening이 술야를 벗어나게 함 • 술자가 오른손잡이 -환축의오른쪽, 왼손잡이 – 왼쪽이 일반적

  9. Ventral midline approach cranioventral

  10. Ventral midline approach

  11. Ventral midline approach

  12. Ventral midline approach

  13. Ventral midline approach

  14. Ventral midline approach Caudoventral, female

  15. Ventral midline approach Caudoventral, male

  16. Ventral midline approach Caudoventral, male

  17. Ventral midline approach Caudoventral, male

  18. Abdominal wall closure • Rectus abdominis m. sheath • Simple interrupted suture: 매우강하게, absorbableor • Simple continuous suture: 파열위험↓, 신속한 폐쇄, absorbable,cranial, caudalend에서 6~8회 매듭surgical gut, stainless X • Cranial2/3 과 Caudal 1/3

  19. Abdominal wall closure • Subcutaneous: subcuticularcontinuous, absorbable • Skin:simpleinterrupted,non-absorbable약하게 할 것 Rectus abdominissheath 봉합

  20. Abdominal wall closure

  21. Paramedian approach • Cryptorchidectomy잠복고환에 직접 접근 가능prepuce와 penis를 제낄 필요가 없음 • 피부, external leaf, rectus abdominis m., internal leaf, transverse fascia, peritoneum 절개 • internal leaf, rectus abdominis m., external leaf따로 봉합

  22. Flank approach • Dorsal쪽 기관. 부신, 신장, 난소 등 • lateral recumbency • EAO, IAO, TA m. • deep circumflex iliac a.의 deep, superficial branch 결찰 • transverse fascia,peritoneum은 thumb forcep으로 들어 절개 • synthetic absorbable material, simple continuous로각층 봉합

  23. Paracoastal approach • 복강 cranial, ventral쪽의 위, 비장, 맹장 • lateral recumbency • 마지막 rib의 1~2cm caudal쪽 • 근섬유 방향 따라 절개 • Simplecontinuous로각각 봉합

  24. 술후 관리 및 평가 • 홍반, 부기, 분비물: 매일2번 검사 • 봉합사 뜯음방지: Elizabeth collar, side bar • 이상 초기증상- 염증, 부종 • 열개- 술후3~5일(이 때 봉합사 약해짐)

  25. Complications • Dehiscence-아래의 경우에서 발생 잘됨 • improper surgical technique • wound infections • fluid or electrolyte imbalances • anemia • hypoproteinemia • metabolic diseases • immunosuppression • corticosteroids • chemotherapeutic agents • radiation

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