Transcript ******** Essential Surgical Skills

外科基本手术操作
Essential Surgical Skills
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切开
止血
解剖分离
打结
缝合
引流
换药
绷带包扎
切开
Incision
（一）切口设计 incision design
1.解剖 要考虑手术区的神经、血管、腮腺导管
等重要组织结构的位置和行径，切口应尽量与
之平行，以免意外损伤和不必要的牺牲
The position and track of the nerves, blood vessels, the parotid gland ducts, and
other important organizational structures are taken into consideration.Incision
should in parallel with them as far as possible in order to avoid accidental
injury and unnecessary sacrifices.
2.部位 功能和美观 Position (Functionality and aesthetics)
（1）隐藏部位和天然皱折处，如颌下、耳前、颌
后、鼻唇沟等。
hiding place and natural buckling such as jaws, nasolabial groove, etc.
（2）皮纹方向一致,以期获得最小、最轻的瘢痕。
the directions of incision and dermatoglyph are
in the same direction as far as possible in
order to obtain the smallest and lightest scar.
（3）活检手术切口应力求与再次手术的切口一致。
the biopsies surgery incision should be consistent with reoperation.
3.长短 Length 充分显露 exposion efficient is better
过长损伤组织多，术后瘢痕大；
Too long : tissue damage↑, postoperative scar↑;
过短显露不清，造成意外损伤，过分牵拉加重损伤。
Too short :Reveals is not clear and easy to cause
accident , It will aggravate injury if using excessive
force .
考虑切口的形状（弧形和“S”形为好）和延长切口的
可能性，以留有余地并获得最佳效果。
Considering the shape of the incision (arc and "S"
shape are well) and the possibility of extension of
the incision, in order to leave room and get the
best effect.
( 二)步骤与注意事项：steps and points for attention
（1）切开前标记 tag before cut
（2） 切开时，皮肤绷紧或固定，手术刀与组织面
垂直，准确、敏捷、整齐、深度一致地一次切开。
cutting：the skin is fixed, scalpel and tissue surface is vertical, disposable incision(accurate,
agile, neat, consistent depth).
（3）注意层次并逐层切开（少数整复手术例外）。
肿瘤手术宜使用电刀或光刀，而整复手术不用，以
期减少瘢痕。
pay attention to the layers and layered cut (a small
number of reconstructive surgery is an exception).
tumor surgery use electrotome or laser scalpel, and
reconstructive surgery need not, in order to reduce the
scar.
（三）体位 The position
应选择利于术野显露的体位，颌下、颈部手术应
常规垫高肩部。
It should be better for the exposure of the
operation field.The shoulder should be higher
if surgery is under the jaw or neck.
（四）照明 lighting
良好的照明可增加术野的清晰度，利于准确操作和
避免意外损伤，这在有重要组织结构和口、咽腔
部位手术时尤为必要。
止血
hemostasis
减少失血 To reduce the loss of blood
保持术野清晰 Keep operation field clear
防止重要组织损伤 Prevent damage from important tissue
保证手术安全Ensure the safety of the operation
术后创口愈合Postoperative wound healing
（一）压迫止血 oppression hemostasis
1.较大面积的静脉渗血或瘢痕组织及某些肿瘤切除时的广泛渗血，温
热盐水纱布压迫止血。
Large-area vein bleeding or extensive bleeding of scar tissue and some
tumor resection -----warm saline gauze
2.局限性出血又查不到明显出血点的疏松组织出血区，可用荷包式或
多圈式缝扎压迫止血。
loose organization bleeding area (limitations of bleeding with no
obvious bleeding area)----- purse type suture
3.组织基底移动性差，不能缝合或缝合效果不佳时，可
转移邻近肌肉或其他组织覆盖、填塞加压止血。
The mobility of organization base is so poor
that can not stitch or the effect not beautiful---- transferable adjacent muscle or other
organizations to fill and stuff .
4.骨髓腔或骨孔内的出血则用骨蜡填充止血。
• Bleeding of the marrow cavity or bone hole ---- bone wax
5.腔窦内出血及颈静脉破裂出血而又不能缝合结扎时，碘仿纱条填塞压
迫止血，以后分期逐渐抽除。
Bleeding of the sinus cavity and jugular vein that can not
be sutured---- tamponade with iodoform gauze
6.急性动脉出血，手指立即压迫出血点，或压迫供应此区知名动脉的近
心端，继而再用其他方法止血。
Acute arterial bleeding ---- oppress the bleeding area
immediately, or oppress the proximal area of this wellknown artery, then use other methods to stop bleeding.
（二）钳夹、结扎止血 clamps, ligation
（1）不可盲目乱夹 do not clip blindly
（2）钳夹的组织宜少 the tissue of being clamped should
be few
（3） 结扎所用的线头应尽量减短 ligation thread should be
shorten as much as possible
（4）可加用缝扎 joint can also be used
（5）大块肌束先钳夹，再剪断，最后缝扎
large muscle bundle clamps first, and then cut, the last
stitch.