手術(shù)講解模板：骶前病損切除術(shù)課件

骶前病損切除術(shù)Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL骶前病損切除1于術(shù)資料:病損切除術(shù)骶前病損切除術(shù)科室:普外科部位:骶骨麻醉:全身麻醉Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL于術(shù)資料:病損切除術(shù)2于術(shù)資料:前病損切除術(shù)概述骶骨腫瘤切除術(shù)用于骨盆骨腫瘤的治療。骶骨切除中有以下四個(gè)方面的問(wèn)題需考慮:Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL于術(shù)資料:前病損切除術(shù)3于術(shù)資料:前病損切除術(shù)概述1.骶骨血運(yùn)豐富,其血運(yùn)由動(dòng)脈有骶中動(dòng)脈、骶旁動(dòng)脈、腰骶動(dòng)脈供應(yīng)(圖3.13.5.2-1~3.13.5.2-3)。加之骶骨松質(zhì)骨多,術(shù)中出血多不易止血Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL于術(shù)資料:前病損切除術(shù)4于術(shù)資料:前病損切除術(shù)概述2.骶管內(nèi)有垂直走行的馬尾神經(jīng),分別自相應(yīng)的骶前孔和骶后孔穿出(圖3.13.5.2-4,3.13.5.2-5)。術(shù)中僅切斷第4、5骶神經(jīng)不影響直腸膀胱功能。如切斷一側(cè)的骶3神經(jīng),則可發(fā)生輕度直腸和膀胱功能障礙,如將兩側(cè)骶3神經(jīng)均切斷,則會(huì)造成嚴(yán)重直腸和膀胱的功能障礙。故術(shù)前應(yīng)考慮并做好病人和家屬的工作。Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL于術(shù)資料:前病損切除術(shù)5于術(shù)資料:前病損切除術(shù)概述3.與盆腔臟器關(guān)系密切。骶骨前后與直腸相鄰,兩者之間為直腸后間隔。腫瘤生長(zhǎng)過(guò)大可與直腸粘連,故有時(shí)需切除部分直腸。另外,脊索瘤的特點(diǎn)之一是侵及周圍的軟組織,有時(shí)侵及范圍較廣,因而增加了手術(shù)的復(fù)雜程度Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL于術(shù)資料:前病損切除術(shù)6于術(shù)資料:前病損切除術(shù)概述4.骶骨是保持骨盆環(huán)穩(wěn)定的重要組成部分,據(jù)Guntesberg測(cè)定:將骶1和骶2之間部分骨質(zhì)切除,其最大負(fù)荷能力減少30%;如果通過(guò)骶1切除骶骨,其最大負(fù)荷能力減少50%。故骶1切除后應(yīng)做重建術(shù),以便術(shù)后患者可站立行走(圖3.13.5.2-63.13.5.2-9)。Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL于術(shù)資料:前病損切除術(shù)7于術(shù)資料:前病損切除術(shù)適應(yīng)證1.原發(fā)于骶骨的骨腫瘤。Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL于術(shù)資料:前病損切除術(shù)8于術(shù)資料:前病損切除術(shù)適應(yīng)證2.周圍組織腫瘤侵及骶骨者。Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL于術(shù)資料:前病損切除術(shù)9于術(shù)資料:前病損切除術(shù)手術(shù)禁忌1.瘤體過(guò)大;在骶骨侵及骶1平面,在骶骨前面腫瘤向盆腔內(nèi)突出較大,切除腫瘤及其邊界不能達(dá)到廣泛性切除者,因術(shù)后復(fù)發(fā)率較高不宜手術(shù)。Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL于術(shù)資料:前病損切除術(shù)10手術(shù)講解模板：骶前病損切除術(shù)課件11手術(shù)講解模板：骶前病損切除術(shù)課件12手術(shù)講解模板：骶前病損切除術(shù)課件13手術(shù)講解模板：骶前病損切除術(shù)課件14手術(shù)講解模板：骶前病損切除術(shù)課件15手術(shù)講解模板：骶前病損切除術(shù)課件16手術(shù)講解模板：骶前病損切除術(shù)課件17手術(shù)講解模板：骶前病損切除術(shù)課件18手術(shù)講解模板：骶前病損切除術(shù)課件19手術(shù)講解模板：骶前病損切除術(shù)課件20手術(shù)講解模板：骶前病損切除術(shù)課件21手術(shù)講解模板：骶前病損切除術(shù)課件22手術(shù)講解模板：骶前病損切除術(shù)課件23手術(shù)講解模板：骶前病損切除術(shù)課件24手術(shù)講解模板：骶前病損切除術(shù)課件25手術(shù)講解模板：骶前病損切除術(shù)課件26手術(shù)講解模板：骶前病損切除術(shù)課件27手術(shù)講解模板：骶前病損切除術(shù)課件28手術(shù)講解模板：骶前病損切除術(shù)課件29手術(shù)講解模板：骶前病損切除術(shù)課件30手術(shù)講解模板：骶前病損切除術(shù)課件31手術(shù)講解模板：骶前病損切除術(shù)課件32手術(shù)講解模板：骶前病損切除術(shù)課件33手術(shù)講解模板：骶前病損切除術(shù)課件34手術(shù)講解模板：骶前病損切除術(shù)課件35手術(shù)講解模板：骶前病損切除術(shù)課件36手術(shù)講解模板：骶前病損切除術(shù)課件37手術(shù)講解模板：骶前病損切除術(shù)課件38手術(shù)講解模板：骶前病損切除術(shù)課件39手術(shù)講解模板：骶前病損切除術(shù)課件40手術(shù)講解模板：骶前病損切除術(shù)課件41手術(shù)講解模板：骶前病損切除術(shù)課件42手術(shù)講解模板：骶前病損切除術(shù)課件43手術(shù)講解模板：骶前病損切除術(shù)課件44手術(shù)講解模板：骶前病損切除術(shù)課件45手術(shù)講解模板：骶前病損切除術(shù)課件46手術(shù)講解模板：骶前病損切除術(shù)課件47手術(shù)講解模板：骶前病損切除術(shù)課件48骶前病損切除術(shù)Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL骶前病損切除49于術(shù)資料:病損切除術(shù)骶前病損切除術(shù)科室:普外科部位:骶骨麻醉:全身麻醉Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL于術(shù)資料:病損切除術(shù)50于術(shù)資料:前病損切除術(shù)概述骶骨腫瘤切除術(shù)用于骨盆骨腫瘤的治療。骶骨切除中有以下四個(gè)方面的問(wèn)題需考慮:Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL于術(shù)資料:前病損切除術(shù)51于術(shù)資料:前病損切除術(shù)概述1.骶骨血運(yùn)豐富,其血運(yùn)由動(dòng)脈有骶中動(dòng)脈、骶旁動(dòng)脈、腰骶動(dòng)脈供應(yīng)(圖3.13.5.2-1~3.13.5.2-3)。加之骶骨松質(zhì)骨多,術(shù)中出血多不易止血Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL于術(shù)資料:前病損切除術(shù)52于術(shù)資料:前病損切除術(shù)概述2.骶管內(nèi)有垂直走行的馬尾神經(jīng),分別自相應(yīng)的骶前孔和骶后孔穿出(圖3.13.5.2-4,3.13.5.2-5)。術(shù)中僅切斷第4、5骶神經(jīng)不影響直腸膀胱功能。如切斷一側(cè)的骶3神經(jīng),則可發(fā)生輕度直腸和膀胱功能障礙,如將兩側(cè)骶3神經(jīng)均切斷,則會(huì)造成嚴(yán)重直腸和膀胱的功能障礙。故術(shù)前應(yīng)考慮并做好病人和家屬的工作。Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL于術(shù)資料:前病損切除術(shù)53于術(shù)資料:前病損切除術(shù)概述3.與盆腔臟器關(guān)系密切。骶骨前后與直腸相鄰,兩者之間為直腸后間隔。腫瘤生長(zhǎng)過(guò)大可與直腸粘連,故有時(shí)需切除部分直腸。另外,脊索瘤的特點(diǎn)之一是侵及周圍的軟組織,有時(shí)侵及范圍較廣,因而增加了手術(shù)的復(fù)雜程度Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL于術(shù)資料:前病損切除術(shù)54于術(shù)資料:前病損切除術(shù)概述4.骶骨是保持骨盆環(huán)穩(wěn)定的重要組成部分,據(jù)Guntesberg測(cè)定:將骶1和骶2之間部分骨質(zhì)切除,其最大負(fù)荷能力減少30%;如果通過(guò)骶1切除骶骨,其最大負(fù)荷能力減少50%。故骶1切除后應(yīng)做重建術(shù),以便術(shù)后患者可站立行走(圖3.13.5.2-63.13.5.2-9)。Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL于術(shù)資料:前病損切除術(shù)55于術(shù)資料:前病損切除術(shù)適應(yīng)證1.原發(fā)于骶骨的骨腫瘤。Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL于術(shù)資料:前病損切除術(shù)56于術(shù)資料:前病損切除術(shù)適應(yīng)證2.周圍組織腫瘤侵及骶骨者。Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL于術(shù)資料:前病損切除術(shù)57于術(shù)資料:前病損切除術(shù)手術(shù)禁忌1.瘤體過(guò)大;在骶骨侵及骶1平面,在骶骨前面腫瘤向盆腔內(nèi)突出較大,切除腫瘤及其邊界不能達(dá)到廣泛性切除者,因術(shù)后復(fù)發(fā)率較高不宜手術(shù)。Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL于術(shù)資料:前病損切除術(shù)58手術(shù)講解模板：骶前病損切除術(shù)課件59手術(shù)講解模板：骶前病損切除術(shù)課件60手術(shù)講解模板：骶前病損切除術(shù)課件61手術(shù)講解模板：骶前病損切除術(shù)課件62手術(shù)講解模板：骶前病損切除術(shù)課件63手術(shù)講解模板：骶前病損切除