眼部手术.ppt

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,第七章 眼部手术,一、眼睑内翻矫正术,【适应症】,下眼睑内翻。,【保定和麻醉】,俯卧保定，全身麻,醉或浸润麻醉。,Blepharospasm,Inturning,Excoriation,Purulent discharge,Secondary uveitis and hypopyon if lesion is severe,Severe conjunctivitis,edema,ulceration,blepharospasm,Miosis（especially if the cornea is ulcerated）,epiphora,epiphora,Dermis hydrated,用,镊子,距睑缘24mm提起皮肤，并用直止血钳或弯,止血钳,将其夹住,【术式】,钳夹长度与内翻睑缘相等，宽度依内翻程度而定(钳夹时眼睑应有一定程度的外翻)。,用力钳压皮肤或用持针钳钳压止血钳，使去除止血钳后皮肤仍皱起,皮肤切口呈月牙形或椭圆形,用4号丝线结节缝合皮肤创缘。缝合要密，保持针距2mm。,二、,眼睑外翻矫正术,【适应症】,下眼睑外翻。,【保定和麻醉】,俯卧保定，全麻或浸润麻醉,【术式一】,Outturned lid,epiphora,Conjunctival congestion and inflammation,距睑外翻下缘23mm处切一“V”,形切口,从尖端向上作“Y”形缝合。边缝合边向上移动皮瓣，直至外翻矫正为止。,矫正后的下眼睑,【术式二】,The lid margin is marked laterally,Modified procedure,An estimate of the amount of margin to be removed is made，and the lid is marked.The ventral end of the triangle is marked 10to14mm below.,The first incision is made with straight Mayo scissors,The triangular piece is removed.,Note that the conjunctival defect is smaller，justifying one layer of sutures in the skin in some cases.,The wound sutured with 60 silk.,【术后护理】,患眼涂布或滴入抗生素眼膏或抗生素眼药水，,34,次,/d,。,颈部安装颈圈，防止自我损伤病眼,术后,1014d,拆线。,术后数日内局部肿胀可逐渐减轻,【,局部解剖,】,位于瞬膜的前下方，被覆脂肪组织。腺体组织分泌的液体经多个导管抵至球结膜表面，提供大约30的水性泪膜。,具有保护角膜、除去角膜上异物、分泌和驱散角膜泪膜及免疫等功能。,有作者认为不宜切除第三眼睑腺(除非组织学证实为恶性肿瘤或严重损伤)，否则易引起角膜结膜炎和干性角膜结膜炎。,【术式】,1.,用组织钳夹住增生物包膜外引使充分暴露。,2.,以小型弯止血钳钳夹蒂部。,3.再以小剪刀或外科刀剪除或切除。,四、Excision of Eyelid Tumors,Eyelid tumors are common in the dog.,The tarsal gland adenoma is the most frequently diagnosed eyelid tumor in the dog.,Less commonly found are,adenocarcinomas,melanomas,and papillomas,.,The tarsal gland adenoma,as with most tumors of the canine eyelid,is clinically benign,and surgical excision is usually curative.,Cryosurgery using 1iquid nitrogen at -20 can also be used to treat these tumors.,【surgical method】,As the conjunctiva is not involved,it is,not removed.Incisions are outlined by,dotted lines.The incisions are marked,on the patient with a plastic surgery,marking pen.The vertical sides of the,triangles are 20 per cent longer than the,vertical incisions adjacent to the tumor,to allow for wound contraction.,A square or rectangular incision is made around the tumor.The tumor is dissected off from the base toward the lid margin.,The tumor is removed and placed in fixative,and is pinned to a piece of cardboard to allow the ophthalmic pathologist to examine the margins for evidence of tumor.,Note,：,If tumor is present in any margin,excision has been incomplete.The previously marked triangle is elevated and excised.,The triangles have been removed and all incisions completed.,To prevent tension on the wound,the tissues surrounding the triangles and the flap are undermined.The flap is advanced to the margin with no tension on it.,Simple marginal sutures of 6-0 silk are placed.Sutures are placed at the corners of the incision to assist in accurate placement of subsequent sutures.,Remaining sutures in place 2 mm apart.If the conjunctiva is mobile it is sutured to the skin edge,filling the defect with a simple continuous suture.This helps prevent retraction of the advancement flap.,【术后护理】,全身应用抗生素,局部温敷，以减轻肿胀和疼痛,术后可能发生渗血，从创口或鼻腔流出血色液体，一般,34d,后可逐渐减少,术后,710d,拆线,五、眼球摘出术,【适应症】,严重眼穿孔、眼突出，眼内肿瘤，难以治愈的青光眼，眼内炎，全眼球炎等。,【保定】,多数采取侧卧保定,【术式】,主要有两种。一是经结膜眼球摘除术；二是经眼睑眼球摘除术，尤其适用于全眼球化脓和眶内肿瘤蔓延到眼睑时。,【麻醉】,大动物可采用全身麻醉或球后麻醉或眼底封闭，小动物通常采用全身麻醉。,A lateral canthotomy is performed.,（一）Enucleation,The globe is dissected free from the conjunctiva via a perilimbal incision.,Extraocular muscle insertions and periorbita are dissected from the globe back to the optic nerve.,The optic nerve is transected and the eye removed.,The cavity is packed with sponges for temporary hemostasis,and the third eyelid is removed completely.,The lid margins are removed,.,The sponges are removed,and the conjunctiva is sutured with 3-0 Vicryl or chromic gut.,The entire lid incision is sutured with 3-0 silk.,（二）Transpalpebral enucleation.,The eyelids are sutured with a simple continuous suture tied at either end,and are held with hemostats,.,A periocular incision is made and dissection carried down outside the extraocular muscles to the apex of the orbit.,The optic nerve and associated vessels are clamped and ligated and transected,.,The optic nerve and associated vessels are clamped and ligated and transected.,Conjunctiva and,Tenons,capsule are sutured with 3-0 chromic gut or Vicryl,and the skin is closed with simple interrupted sutures of a,nonabsorbable,material appropriate for the size and environment of the patient,六、眼睑损伤的修复,Wound after debridement and ready for suturing.,The conjunctiva is sutured with 6-0 Vicryl in a simple,continuous pattern.,The marginal suture is placed first,in two separate bites,.,The second bite.,The marginal suture is carefully tied to ensure apposition of the margins.The knot lies along the margin.The wound is sutured with simple interrupted suture of 6-0 silk.The first suture beneath the margin relieves tension on the marginal suture.,The wound sutured,.,A figure-eight suture pattern may be used in place of the first two sutures.,The wound sutured using a figure-eight technique.,谢 谢 大 家！,