surgicalnursing教學(xué)內(nèi)容

1、Good is good, but better carries it.精益求精，善益求善。surgicalnursing-Surgicalnursing外科護理學(xué)Instrumentpacks595器械包Postoperativecare597術(shù)后護理Abdominalsurgery598腹部外科Aural603耳部/聽覺Integument605皮膚Ophthalmic608眼睛Orthopedic611矯形外科Reproductivetractsurgery614生殖道外科Thoracicsurgery618胸腔外科Urogenitaltractsurgery620泌尿道外科Manyof

2、thelistedsurgicalproceduresmaynotbeperformedintheaverageclinicalsetting.however,atonepointoranother,technicianswillbefacedwithhavingtoexplainaparticularproceduretoaclient.許多列舉的手術(shù)操作在普通的臨床環(huán)境沒有辦法操作。然而，技術(shù)人員經(jīng)常會面臨要將特殊的操作解釋給主人。Thesedescriptionsarenotmeantasdirectionsonhowtoperformtheprocedure,butratheraqui

3、cksynopsisthatwillallowthetechniciantopreparefortheprocedure,managepatientcare,andclearlyexplaintheprocedureandaftercaretoaclientwhosepetmaybeundergoingtheseprocedures.這些描述不是作為如何進行手術(shù)操作的指導(dǎo)，而是一種能夠讓技術(shù)人員準備手術(shù)，進行患畜護理的概要和能夠?qū)⒒夹蠹磳⒚媾R的操作和術(shù)后護理清晰的將給主人。Witheverysurgicalprocedure,painmanagementneedstobeaddressedan

4、dhandled.Refertochapter8,PainManagement,formoreinformation.對于每個手術(shù)操作，疼痛管理都是需要強調(diào)和給予的?？梢詤⒖嫉诎苏?，疼痛管理獲得更多的信息。Instrumentpacks器械包Thesepacksareexamplesoftheinstrumentsincludedinbasicsurgicalpacks.Eachclinicwillneedtoorganizepacksthatbestfittheirsurgerytypeandsurgeon.Eachsurgeonhaspreferencesonindividualtypes

5、ofinstrumentsfordifferentsurgeries.Eachpackmayincludegauze,laparotomypads,towels,salinebowl,needles,sutures,andscalpelblades,ortheymaybepreparedseparately.以下的器械包是器械的例子，包括基本的外科包。每個診所要組織器械包使它更適合不同的外科手術(shù)類型和外科醫(yī)生。每個外科醫(yī)生對于不同的手術(shù)會選擇個人喜好的器械。每個器械包應(yīng)該包含紗布，毛巾，縫針，手術(shù)刀片，創(chuàng)巾等或者它們需要單獨包裝。Basicsurgicalpacks基本外科器械包Abdomin

6、alpack腹部手術(shù)器械包Abdominalforceps腹部鑷子Abdominalretractors腹壁牽開器BalfourretractorGeneralsurgicalpack一般的外科包GroovrddirectorHemostats止血鉗Needleholders持針器Retractors牽引器Scalpelhandle解剖刀柄Scissors剪刀Spayhook卵巢牽引鉤Thumbforceps按捏鑷,組織鑷Tissueforceps組織鑷Towelclamps巾鉗Lacerationpack傷口縫合器械包Hemostats止血鉗Needleholder持針器Scalpelhan

7、dle解剖刀柄Scissors剪刀Thumbforceps按捏鑷，組織鑷Ophthalmicpack眼科器械包Eyelidforceps眼瞼鑷Eyelidretractor開瞼器,瞼牽開器Hemostats止血鉗Lacrimalcannulas淚管插管Needleholders持針器Scalpelhandle解剖刀柄Scissors剪刀Thumbforceps有齒鑷Orthopedicpack矯形外科器械包Bonedrill骨鉆Bonechuckandkey骨卡盤和鑰匙Bone-cuttingforceps骨剪Bone-holdingforceps持骨鉗Boneraspsandfiles骨銼和

8、？GiglihandlesandwireMallet鼓槌Osteotome骨鑿,骨刀RothopedicwirePeriostealelevator骨膜起子,骨膜分離器,骨膜剝離器Pincutter剪釘鉗,鋼絲鉗,斷針鉗Retractors牽引器SennretractorVolkmannretractorRongeurs修骨鉗,咬骨鉗Wire-cuttingscissors線剪Thoracicpack胸部手術(shù)器械包Generalsurgicalpackinstrumentswithlonghandles常規(guī)外科器械包內(nèi)的長柄器械Ribretractors肋骨牽開器Wilsonribspread

9、erWilson肋骨牽開器Bone-cuttingforceps骨剪Right-angleforceps直角鉗Vesselclamps導(dǎo)管夾,動脈止血鉗Bulldogclamp顯微外科用的無損傷鉗，動脈夾Specializedsurgicalpacks特殊的外科器械包Manyinstrumentsmaybeusedonlyonoccasionandshouldbesetasideinseparatepacks.Instrumentsweakenwithconstantscrubbingandautoclavingandshouldthereforenotbesubjectedtounneces

10、sarysterilization.Theinstrumenttypeandnumberincludedineachofthesepackswilldependonsurgeonpreference.許多器械只是偶爾使用，應(yīng)該單獨打器械包。經(jīng)常的刷洗和高壓滅菌會使器械變鈍，因此不應(yīng)該進行不必要的滅菌。Biopsy/thephinepack活組織檢查包Curettepack刮匙包Hemostatpack止血鉗包Implantset植入物放置Periostealelevatorpack骨膜起子,骨膜分離器,骨膜剝離器包PinsetRetractorpack牽引器包Screwsetsuctionti

11、psandtubingpack螺絲釘吸引頭和？包Postoperativecare術(shù)后護理Thesuccessofeachsurgicalprocedureoftenliesinthepatientcarethatfollowstheprocedure.Thisoftenendswiththeclienttocontinueathomecare.Clearandconciseinstructionsarecriticaltoenablethistransitiontooccursuccessfully.Clientsshouldbestronglyencouragedtophoneforany

12、questionsorconcernsarise.Follow-upphonecalls1-2daysafterasurgicalprocedurebythestaffwillalsoencourageclientcommunication.每個外科手術(shù)操作的成功經(jīng)?；趯夹蟮男g(shù)后護理。這些經(jīng)常以主人將患畜接回家后繼續(xù)護理而終止。清晰簡要的說明是使這個過渡成功的關(guān)鍵。應(yīng)該鼓勵患畜主人在有任何疑問和擔心打電話來咨詢。應(yīng)該鼓勵醫(yī)務(wù)人員外科手術(shù)后的1-2天給主人打電話進行交流。Skillbox12-1/Standardpostoperativecareinstructions技術(shù)表格12-1/標準

13、的術(shù)后護理說明Feedonlyhalfofthenormalfoodandwaterthefirsteveningaftersurgery外科手術(shù)當天晚上只要喂平常食量和水量的一半Checkincisiondailyforredness,swelling,discharge,orodor每日檢查傷口是否發(fā)紅、腫脹、滲液或者有異味Preventlicking,chewing,orrubbingatincisionlineorsutures制止動物舔舐、拒絕或者摩擦縫線Keeptheanimaland/orbandagesdryandclean保持動物的包扎繃帶干燥清潔Avoidbathingor

14、swimminguntilsutureremovalorfor5-7dayswithscSutures在未拆線之前禁止洗澡和游泳？Phonethedoctorifanyofthefollowingoccur:RepeatedvomitingExtremelistlessnessBleedingordischargeLossofappetitefor24hoursOpenedincisionlines如果遇到以下情況請致電醫(yī)生：反復(fù)嘔吐、非常沒有精神、出血或者滲出、24小時沒有食欲、傷口開線Skillbox12-2/preventinglicking,chewing,orrubbingatinc

15、isionsiteorsutures技術(shù)表格12-2/制止動物舔舐、拒絕或者摩擦傷口或者縫線1useanelizabethancollar(e-collar,neckbrace,etc.)atalltime1要一直帶著伊麗莎白圈2applyabandage(e.g.,softpaddedbandage,hobbles,orschroeder-thomassplintwithsheetaluminum)2應(yīng)用繃帶（軟墊繃帶？或者鋁片schroeder-thomas夾板）3Foul-tastingsubstance(e.g.,bitterapple,atropine,tabasco,orthumb

16、-suckingpreparations)3使用異味物質(zhì)（藥西瓜瓤、阿托品、辣椒粉、吮指癖制止劑）4covertheareawithasock,babyt-shirt,orstockinette4將術(shù)部用短的幼兒T恤或者？覆蓋5bodybrace,sidebar,ortail-tipprotectorTable12-1abdominalsurgeryprocedureAbdominalsurgerydefinitionSeeparticularsurgeryindicationsSeeparticularsurgerypreparationinstrumentsAbdominalpackEle

17、ctrocauteryGauzesponges/laparotomypadsGeneralsurgicalpackRetractorpackSalinebowlSaline,warmedSuctiontipsandtubingpackpatientSeeparticularsurgerySurgicaltechniqueThorganorareatobeexaminedshouldbeexteriorizedandpackedwithsalinemoistenedgauzespongesAlltissuesmustbekeptconsistentlymoistwithwarmsalineHan

18、dlingoftheinternalorgansmustbedonecarefullytoavoidfurtherdamage,butsecureenoughtonotallowleakageofthebowelcontentsintothesurgerysiteProvideclean,steriledrapes,towels,gloves,andinstrumentsforabdominalclosurePatientshouldbemonitoredforexcessivebloodloss,contaminationofpertonealcavity,andantendencytovo

19、mitwithorganmanipulationcomplicationsproceduralAbscessDehiscenceGastricorintestinalperforationHemorrhage(e.g.,poorhemostasisandinadvertantinjurytovascularorgans)IleusIntestinalstricturePancreatitisPeritonitis/sepsis(e.g.,contaminationwithgastrointestinaltract(GIT)content)PleuraleffusionFailureofinte

20、ndedsurgeryAdhesionsbetweenvisceralsurfacespatientHyperthaermiawithprolongedproceduresAbdominalpainFecalincontinenceFeverTenesmus/constipation/dyscheziaVomitingFollow-upPatientcareNPOfor12-24hoursAnalgesiapostoperativelyMonitorability,frequency,andappearanceofdefecationStandardpostoperativecareConfi

21、neandrestrictactivityuntilsuture/stapleremovalorasdirectedbyDVMClenteducationRecheck/sutureremovalin_daysMedication:_Labresultsin_daysTable12-1腹部外科操作步驟腹部外科定義見詳細外科說明適應(yīng)癥見詳細外科說明準備器械腹部外科包電烙器紗布海綿/剖腹術(shù)墊子常用外科填塞物牽引器包Salinebowl溫生理鹽水吸引頭和管包患畜見詳細外科說明外科技術(shù)需要從腹部取出進行檢查的器官或者區(qū)域需要用生理鹽水潤濕的紗布海綿包裹覆蓋需要使用溫的生理鹽水讓所有的組織保持濕潤處理內(nèi)

22、臟的時候必須要仔細，避免對組織的進一步損傷，要盡量避免腸內(nèi)容物漏入外科手術(shù)區(qū)域為腹腔閉合提供干凈無菌的布單、毛巾、手套和器械需要監(jiān)控患畜是否有過度失血，？腔污染和器官操作引增加的嘔吐的可能性并發(fā)癥程序膿腫開裂胃腸穿孔出血（止血功能弱或者未注意損傷到了脈管器官）腸梗阻腸狹窄胰腺炎腹膜炎/敗血癥（胃腸道內(nèi)容物污染）胸膜積液預(yù)期外科手術(shù)失敗臟面粘連患畜卵泡膜細胞增殖癥使發(fā)情延長腹部疼痛大便失禁發(fā)燒里急后重/便秘/大便困難嘔吐后續(xù)患畜護理禁食12-24小時術(shù)后鎮(zhèn)痛監(jiān)測排便能力、頻率和表現(xiàn)標準的術(shù)后護理限制活動直到拆線或者由獸醫(yī)進行指導(dǎo)客戶教育在_天復(fù)查/拆線藥物治療方案：_天獲得實驗室結(jié)果Table1

23、2-2abdominalsurgery(continued)procedureAbdominalherniaAnalsacculectomycolotomydefinitionRepairofaholeintheabdominalwallthatisallowinganorganorpartofanorgantoprotrudeRemovalof1orbothanalsacsandassociatedanalsacductIncisionmadeintothecolonindicationsIntestinalobstructionand/orstrangulationdamageCorrec

24、tionoflong-termanalsacinfectionandneoplasiaFull-thicknessbiopsyandforeignbodyPatientpreparationDorsalrecumbencyPrepare3oneithersideoftheherniaVentralrecumbencywithrearlegsdrapedoverendoftableandtailsecuredcraniallyPreparea4radiusaroundanusExpressanalsacs,evacuateasmuchofthefecesfromthecolonaspossibl

25、e,andpackrectumwithspongesClosed；instillself-hardeninggelorresinintosac(s)toberemovedmultipleenemastoriskofinfectionandtovisibilityDorsalrecumbencyPrepareentireventralabdomenSurgicaltechniqueAnincisionismadeovertheherniaanddissecteddowntotheherniaorifice,Anyadhesionsareremovedandtheorgansand/orvisce

26、raarereturnedtotheperitonealcavity.Theedgesofhernialorificearesharplyfreshenedandsuturedclosed.RoutineclosureoftheabdomenisperformedClosed:thehardenedsacisisolated,andanincisionismadeoverthesac.Thesurroundingtissueisgentlydissectedawayfromthesac,andthesacandductareremoved.Theareaislavagedwithwarmeds

27、aline,andtheremainingtissueisclosedinaroutineclosure.Open:Theanalsacorificeisvisualizedandagrooveddirectorisplacedintothesacorificetothemostventralaspect.Anincisionismadealongthegrooveddirector,andtheentiresacandductaredissectedout.Theareaislavagedwithwarmedsaline,andtheremainingtissueisclosedinarou

28、tinclosureAcaudalmidlineabdominalincisionismade.Theaffectedareaisexteriorizedandpackedwithsaline-moistenedgauzesponges.Staysuturesareplaced,andthecoloniccontentsaremilkedawayfromtheintendedincisionsite.Anincisionismadeintothecolon,andtheforeignbodyisremovedorbiopsyspecimentstaken.Thecolotomyisclosed

29、,andtheabdomenisflushedwithwarmsaline.Thecolotomyiscoveredandtackedwithapieceofomentum,androutineclosureoftheabdomenisperformed.notesClienteducation:chronicherniasmaynotrequiresurgicalinterventionInstruments:closed:self-hardeninggelorresinandadministrationequipmentOpen:grooveddirectorSurgery:careful

30、,atraumaticdissectionwithminimalmuscledamageisessentialtoprevervenerveandsphincterfunctionPatientcare:hotpackthesurgicalsiteimmediatelyaftersurgeryandantibioticsfor7-10dayspostoperativelyClienteducation:hotpackincisiontwicedailyuntilsutureremovalSurgery:staysuturesmaynjotbenecessary,especiallyifsurg

31、icalassistantispresentPatientcare:antibioticsduringsurgeryandpostoperatively(onlyifcontaminationissuspected)Table12-2腹部外科（繼續(xù)）程序步驟腹部疝氣Analsacculectomy肛門腺囊結(jié)腸切開術(shù)定義修復(fù)能夠使部分器官或者整個器官突出腹壁的洞Removalof1orbothanalsacsandassociatedanalsacduct移除一個或者雙側(cè)的肛門腺囊和？結(jié)腸切開適應(yīng)癥腸梗阻或窒息,絞窄損傷校正長期的肛門腺囊感染和瘤形成Full-thicknessbiopsyand

32、foreignbody增厚部位的活組織采樣和異物患畜準備背側(cè)斜臥Prepare3oneithersideofthehernia準備雙側(cè)的疝氣VentralrecumbencywithrearlegsdrapedoverendoftableandtailsecuredcraniallyPreparea4radiusaroundanusExpressanalsacs,evacuateasmuchofthefecesfromthecolonaspossible,andpackrectumwithspongesClosed；instillself-hardeninggelorresinintosac(

33、s)toberemoved多次灌腸可以降低感染的風(fēng)險并且增加可視度背側(cè)斜臥準備整個腹部腹側(cè)外科技術(shù)從疝氣表面切開至疝孔，除去粘連物并將器官或臟器還納入腹膜腔。將疝孔邊緣切割形成新鮮創(chuàng)，并由縫線閉合。常規(guī)閉合腹腔封閉式：堅硬的囊相對獨立，在囊上做切口。輕柔的分離囊、囊管和囊周圍的組織。用溫生理鹽水沖洗周圍區(qū)域，將剩余的組織常規(guī)閉合開放式：肛周腺囊的口是可見的，將有槽探針從囊孔置于大部分腹側(cè)位置。沿著有槽探針周圍做切口將整個囊和管切除。用溫生理鹽水沖洗附近區(qū)域，常規(guī)閉合剩余組織后腹部中線切口。受影響的區(qū)域是從腹腔取出的臟器，需用生理鹽水浸潤的紗布海綿包裹，將傷口周圍的縫處置好，將結(jié)腸內(nèi)容物從預(yù)計的

34、切口處擠走。將結(jié)腸切開，將異物取出或者進行活組織標本采樣。將結(jié)腸封閉，用溫生理鹽水沖洗腹腔。用網(wǎng)膜將結(jié)腸覆蓋，常規(guī)閉合腹腔。注意客戶教育：慢性疝氣不需要外科手術(shù)的干預(yù)器械閉合式：自我凝固的凝膠或者樹脂及其投藥的裝置開放式：有槽的探針外科：仔細的最小損傷肌肉進行切割以保護神經(jīng)和括約肌的功能患畜保護：術(shù)后對傷口進行熱敷，并進行消毒7-10天客戶教育：熱敷傷口兩次知道拆線外科手術(shù)：尤其是外科助手在的情況下，staysutures是非必須的。Patientcare:antibioticsduringsurgeryandpostoperatively(onlyifcontaminationissuspe

35、cted)患畜護理：術(shù)中和術(shù)后需要抗生素治療（只有如果懷疑污染的時候）Table12-3abdominalsurgety(continued)procedureenterotomyGastric-dilatationvolvulus(GDV)seechapter5,emergencycareGastrotomydefinitionIncisionmadeintothesmallintestinesTorepositionthestomachandthespleenintheircorrectlocationandrestoretheirbloodcirculationFixthestomach

36、totheabdominalwalltopreventfurthertorsionIncisionmadeintothestomachIndicationsExaminationforulcers,strictures,orneoplasia,full-thicknessbiopsy,andforeignbody(FB)removalAstomachthatdilatesandtwistsarounditscentralaxisFull-thicknessbiopsyandforeignbody(FB)removalPatientpreparationDorsalrecumbencyPrepa

37、reentireabdomenOrogastricdecompressionorneedletrocarizationDorsalrecumbencyPreparemidsternumto2-3inchesbelowtheumbilicusDorsalrecumbencyPreparebottomthirdofthesternumto2-3inchesbelowtheumbilicusSurgicalthchniqueAmidlineabdominalincisionismade.Theaffectedareaisexteriorizedandpackedwithsaline-moistene

38、dgauzesponges.Staysuturesareplaced,andthebowedcontentsaremilkedawayfromtheintendedincisionsite.Anincisionismadeintotheintestines,andtheFBisremovedorbiopsyspecimenstaken.Theintestinesareexaminedforviabilityandrecection,andanastomosisisperformedifnecessary.Theenterotomyisclosedwithapieceofomentumandta

39、cked,androutineclosureoftheabdomenisperformed.Amidlineabdominalincisionismade.Furtherorogastricdecompressionisperformedifnecessaryviaanorogastrictubeorsuction,Thespleenisevaluatedforrotationandnecrosis.Asplenectomyisperformedifthereissplenicnecrosis.Gastroplexyisthenperformedontherightsideofthedogby

40、oneofmanymethods,Theabdomenisthenclosednwithroutineclosure.Acranialmidlineabdominalincisionismade.Thestomachisexteriorizedandpackedwithsalinemoistenedgauzesponges.Staysuturesareplaced.Thestomachisexcisedintoandsuctionedfreeofliquidcontents.TheFBisremovedorbiopsyspecimenstaken.Thestomachisclosedinamu

41、lti-layerfashion,lavagedwithwarmedsaline,andpossiblycoveredwithomentum.Theabdomenisclosedroutinely.notesSurgery:staysuturesmaynotbenecessary,especiallyifasurgicalassistantispresentSurgery:enterotomyincisionsareusuallymadeintissueadjacenttotheFBratherthandirectlyoveritforbetterincisionhealingInstrume

42、nts:orogastrictubePatientcare:monitorelectrolytes,bloodgases,hematocrit(Hct),totalprotein(TP),urinaryoutput,electrocardiogram(ECG),andcentralvenouspressure(CVP)asnecessary,andkeepNOPfor24-48hoursClienteducation:feedsmallmeals3-4timesdaily,andavoidexerciseaftereachmeal.NoneTable12-4abdominalsurgery(c

43、ontinued)procedureIntestinalresectionandanastomosisHepatectomy,partialdefinitionremovalofadiseasedornonviablesectionoftheintestinesandrepairtothebowelwithend-to-endbowelreattachmentremovalof1weekSurgical:Flushingfluidsshouldnotcontainsugars,becausethatprovidesnutrientsforthepathogens,andeliminatings

44、kintensionatsuturelineisimperativeforhealingPostoperatively:bandageandimmobilizeforhealingandtoswellingTable12-9integumentsurgery(continued)procedureMassremovalOnychectomy(declaw)DefinitionRemovalofatumor,mass,growth,orcystRemovalofthenailandentirethirdphalanxIndicationsObstructionwithfunction,neopl

45、asia,orcosmeticTrauma,infection,orneoplasiaPatientpreparationPositionedtoallowaccesstotheaffectedsitePreparethesitetoincludethelocationofswellingwithanadditional1-2marginLargermarginswhenneoplasiaissuspectedorconfirmedasmalignantAnalgesicsareadministeredbeforetheprocedureLateralrecumbencyPawsareclip

46、pediflonghairispresent,washed,andsprayedwithanantisepticSurgicaltechniqueVaryingtechniquesareemployedforthevaryingsizesandshapesofspecifictumorsAnellipticalincisionismadearoundtherumor,anditisdissectedout.Adequatehemostasisisapplied.Thedeadspaceisclosedviasutures,andadrainmaybeplaced.Theskinedgesare

47、apposedandsuturedclosed.Thebloodismilkedproximally,andarourniquetisplacedproximaltotheelbow.Thetoesarethenclosedwithsurureortissueglue.Asecurebandageisplacedtopreventhemorrhage.notesPatientcare:bandageInstruments:Tourniquet,skinglue,andsterilenailtrimmersSurgicalcomplications:thethirdphalanxmustbere

48、movedfromeachtoetoavoidadditionalpainandnailregrowth,infection,“phantom”painsensation,and/oroccasionallimpingPatientcomplications:patientbitingasasubstituteforclawingClienteducation:painmedication:_Table12-10ophthalmicsurgeryprocedureintegumentsurgeryDefinitionseeparticularsurgeryindicationsseeparti

49、cularsurgeryPreparationInstrumentsophthalmicsurgicalpackeyelidspeculumPatientventralrecumbencywiththeheadproppeduponatowelorcushionplaceasterileophthalmicointmentintheeyetoprotectfromclippedhairandcleaningsolutionsprepareareaimmediatelyaroundeyeSurgicaltechniqueseeparticularsurgerycomplicationsProce

50、duralfailureofintendedsurgeryinfectiontissuenecrosiskeratitissecondarytocornealdryingand/ortraumaPatientswellingpainFollow-upPatientcareanalgesiapostoperativelystandardpostoperativecareconfineandrestrictactivityuntilsuture/stapleremovalorasdirectedbyDVMClienteducationRecheck/sutureremovalin_daysMedi

51、cation:_Laboratotyresultsin_daysTable12-11ophthalmicsurgery(continued)procedurecataractsEntropion(ventral,dorsal,lateralormedial)enucleationdefinitionRemovaloftheanteriorlensthroughsurgicalremovalorphysicaldissolutionRemovalofasectionofeyelidskin,dependingonthetypeofentropionRemovaloftheeye(globe)in

52、dicationsOpacityofthelens,whichcouldleadtouveitis,glaucoma,visualdeficits,orretinaldetachmentInwardrollingoftheeyelid,resultinginkeratitis,cornealulceration,andpainGlaucoma,trauma,neoplasia,oroculardiseasesSurgicaltechniqueExtracapsularextraction:Acornealorcorneoscleralincisionismade,andtheanteriorl

53、enscapsuleisremovedPhacofragmentation:Anultrasound-drivenneedleisusedtoemulsifyandremovetheaffectedlenssimultaneouslyAnintraocularlensisoftenplacedtofurthervisionAnellipticalorV-shapedareaofskinisremoved,dependingonthelocationoftheentropion.Theareaisthensuturedclosedwithanonabosorbablesuture,anllowi

54、ngthelidtoremaininnormalanatomicposition.Transconjunctival:Anincisionismadeatthelateralcanthus,andtheeyeisstabilized.Theeyeisdissectiedthroughthemuscleattachments,opticnerve,andbloodvesselsandthenremoved.Thetissuesarethensuturedinalayeredfashion.Transpalpebral:Theeyelidsaresuturedclosed,andanellipti

55、calincisionismade5-6mmfromtheeyelidmargin.SeeabovenotesIndications:mustbedistinguishedfromnuclearsclerosisPatientcare:inflammationmustbecontrolledforsuccessSurgical:evertingsuturesmaybeusedtemporarilyinyoungdogsforcorrectionwithoutexcisionofanyeyelidskinComplications:hemorrhage(e.g.,angularisoculive

56、inissevered.)Table12-12ophthalmicsurgery(continued)procedureglaucomaNictitatingmembraneflapreplacementProlapsedoftheglandofthethirdeyelid(cherryeye)definitionTotheproductionandoutflowofaqueoushumorandtoocularpressureTemporaryattachmentofthenictitatingmembranetotheupperpalpebraforcornealsupportReposi

57、tioningofthethirdeyelidglandandanchoringinamorenormalpositionindicationsToretainvisionandnormalintraocularpressureandpainDeepcornealulcers,trauma,orcornealdiseasesasatemporarybandageduringhealingHypertrophyandprolapsedofthethirdeyelidglandSurgicaltechniqueLasercyclophotocoagulation:killingsmallareas

58、oftheciliarybodyviaalaserCyclocryotherapy；freezingtheciliarybodyinmultiplesites(4-8)withliquidnitrogenadministeredviaacyroprobeAnteriorchambershunts:implantationofatubetoallowcontinuousdrainageofaqueousfluidThenictitansissuturedtotheuppereyelidorbulbarconjunctiva,incorporatingbuttonsorsilastictubing

59、topreventtissuenecrosisfromthesutures.Pocket:anincisionismadealongthemarginsoftheglandintothepalpebralconjunctiva.Apocketisformed,andtheglandisreturnedtoitsnormalposition,Theincisionisthensuturedtogetheroverthegland.Pursestring:thethirdeyelidisexposedandstabilized.Apursestringsutureisplacedoverbothe

60、ndsofthegland.Theglandisreturnedtonormalpositionwithacotton-tippedapplicator,andthepursestringsutureispulledtightandknotted.notesClienteducation:painful,blindyeyswillnotbenefitfromtheabove-mentionedsurgeriesandshouldbeenucleatedComplication:suturesmaypullthroughwithexcesstensionClienteducation:sutur