04安全切開和閉合消化道-surgery

OpenandclosethedigestiveUniv.Prof.Dr.OpenandclosethedigestiveUniv.Prof.Dr.GillesDipl.DIU erventionnelle,DIUierchirurgie,VETERIN?RMEDIZINISCHEUNIVERSIT?WIE安全切開和閉合消化當(dāng)前知Basicscience基當(dāng)前知Basicscience基礎(chǔ)科Structureandhealing結(jié)構(gòu)和愈Suturetechnique縫合技Suturematerial縫合材Operativeenvironment手術(shù)環(huán)Specifictechniques特殊技t-operativeenvironment術(shù)漿肌漿肌粘膜下粘TheSerosa,alwaysTheSerosa,alwaysthe漿膜，總是漿Thesubmucosa???bloodsupply?Thesubmucosa???bloodsupply?Digestivetract消化道Digestivetract消化道愈Lagphase延滯Proliferative增長(zhǎng)Maturation成熟:0-4:3-14:10-180DigestivetractLagphase延滯DigestivetractLagphase延滯:0-4:3-14:10-180prolongstheprolongsthelagCurrent當(dāng)前知BasicCurrent當(dāng)前知Basicscience基礎(chǔ)科Structureandhealing結(jié)構(gòu)和愈Suturetechnique縫合技Suturematerial縫合材Operativeenvironment手術(shù)環(huán)Specifictechniques特殊技t-operativeenvironment術(shù)Everting,外翻，Everting,外翻，內(nèi)翻Everting,外翻，內(nèi)翻Everting,外翻，內(nèi)翻40－60itionalleadstobetter對(duì)位良好itionalleadstobetter對(duì)位良好可最大限度減少狹CisetalSurg.Gynecol.Obstet.,Ellisonetal,JAAHA,1982BellengerAust.Vet.JWhatdoesasecondlayerWhatdoesasecondlayerAsecondlayeritionalAsecondlayeritional適合做二層縫erruptedor結(jié)節(jié)縫合或連續(xù)縫erruptedor結(jié)節(jié)縫合或連續(xù)縫IncludetheIncludethe包括粘CurrentBasicscience基礎(chǔ)科CurrentBasicscience基礎(chǔ)科Structureandhealing結(jié)構(gòu)和愈Suturetechnique縫合技Suturematerial縫合材Operativeenvironment手術(shù)環(huán)Specifictechniques特殊技t-operativeenvironment術(shù)Current當(dāng)前知BasicCurrent當(dāng)前知Basicscience基礎(chǔ)科Structureandhealing結(jié)構(gòu)和愈Suturetechnique縫合技Suturematerial縫合材Operativeenvironment手術(shù)環(huán)Specifictechniques特殊技t-operativeenvironment術(shù)Patient’sPeritonitisForeignbody,Alb<2.5g/dlS.Patient’sPeritonitisForeignbody,Alb<2.5g/dlS.ChristopherRalphs,JAVMA2003,RiskfactorsforleakaSurgeon’s外科醫(yī)Surgeon’s外科醫(yī)生影estinalBiopsies/腸道estinalBiopsies/腸道活組織取樣/腸道切estinalresection腸切除estinalresection腸切除術(shù)estinalresection腸切除術(shù)estinalresection腸切除術(shù)estinalresection腸切estinalresection腸切除術(shù)estinalanastomosis腸吻合術(shù)estinalanastomosis腸吻合術(shù)Anastomosis:吻合術(shù)：閉連續(xù)Anastomosis:吻合術(shù)：閉連續(xù)estinalanastomosis腸吻合術(shù)結(jié)estinalanastomosis腸吻合術(shù)結(jié)estinalanastomosis腸吻合estinalanastomosis腸吻合術(shù)Adapt使Adapt使直徑適Adapt使直徑Adapt使直徑適IsitviableIsitviable是否能存活BussemakerJBetall,Ann.Surg1972,176,97-101WheatonLGetall,JAAHA,19,897-902,1982Isitviable是否能存Isitviable是否能存活Other其它技Fluorescein熒光染 95accuratefornonviable58%accuratefor58％確定能夠存Doppler血Pulseoxymetry脈搏血氧測(cè)Mostcommonerror常犯的錯(cuò)Resectionofviablesegments切除可存活腸Isitviable是否能存活I(lǐng)sitviable是否能存活切除大段腸管或切除多段腸管Limitsoflarge大段腸管切除的限Limitsoflarge大段腸管切除的限>%切除范圍超過(guò)75％可引起短腸綜合Howtoavoidmassive怎樣避免大范Howtoavoidmassive怎樣避免大范圍切除?TheserosalpatchvascularbutviableareasSerosal漿膜Serosal漿膜Particularitiesof特殊胃閉合Particularitiesof特殊胃閉合Lowbacteriacount細(xì)菌LowNoroblem無(wú)管腔大小問(wèn)題Gastricclosure胃閉OnelayerGastricclosure胃閉OnelayerSI單層簡(jiǎn)單間斷縫Twolayers雙Mucosa(1)-Seromusculosa粘膜（1－漿膜肌層itionalInverting同一位置/換位Current當(dāng)前知Current當(dāng)前知Basicscience基礎(chǔ)科Structureandhealing結(jié)構(gòu)和愈Suturetechnique縫合技Suturematerial縫合材Specifictechniques特殊技t-operativeenvironment術(shù)后環(huán)Howtobeestinalsurgery腸道手Howtobeestinalsurgery腸道手術(shù)如何成功Theywon’teat他們不想吃Stickatubein插OpenandcloseOpena