cea手術(shù)室篇(文件)
【正文】 s so that once the lumen is entered, the blade can be drawn outwards to mence a longitudinal arteriotomy. 技巧：切開動脈壁時：可標記切口，以確保方向； The arteriotomy is slightly lateral to the midline (from the surgeon’s point of vision)。 遠端 : the arteriotomy on the anterolateral aspect of the internal carotid is taken beyond the severe disease, this being usually within 1–2 centimeters of its origin。 ? 處置方式： Cut through the plaque to the lumen, cutting it longitudinally until the healthy ICA is reached。 Proximally, obtaining a satisfactory end point may be more difficult. Distally, it is advisable to follow the atheroma until it reaches its thin end point。 縫合前的要求： good end points: all three carotid vessels。 IV. More knots are used – usually 7 – and the ends of the stitches are cut longer, some 5–6 mm from the knots. 第四十八頁，共六十一頁。 ? The arteriotomy usually leaks a small amount and sometimes even a small jet of blood may be encountered. Add extra stitches? Leaking arteriotomy is covered for some 3–5 min by muslin soaked in warm Ringer solution。 局部出血的觀察 ? Hemorrhage: dressing, neck swelling, with or without tracheal pression, and blood collected in the drainage bottle ? Continued hemorrhage of greater than 100 ml/h and/or tracheal pression may require reexploration, evacuation of the hematoma and securing hemostasis. 第五十二頁，共六十一頁。 術(shù)中解剖演示 第五十六頁，共六十一頁。 您的聆聽 第六十頁，共六十一頁。 。 the CCA, C window aneurysm clip at the ICA, P plaque, T superior thyroid artery。 We are A Team 第五十八頁，共六十一頁。 HOW TO AVOID COMPLICATIONS ? PATIENT SELECTION ? ANAESTHESIA (gentle and smooth anaesthesia) ? MONITORING (諸多方面： BP，術(shù)中轉(zhuǎn)流的監(jiān)測，血管縫合后的即刻監(jiān)測，術(shù)后切口的觀察等 ) ? DISSECTION AND ENDARTERECTOMY ? CROSS CLAMPING 〔 Proper sequence of clip application and removal decreases the risk of perioperative embolisation.〕 ? HAEMOSTASIS 〔 meticulous haemostasis〕 ? HEPARIN NONREVERSAL ? POSTOPERATIVE CARE 第五十四頁，共六十一頁。 ? suction drain ? Carotid sheath。 I. After the arteriotomy is closed, the ICA clip is briefly (1 sec) opened. II. The clips are then removed from the ECA, the superior thyroid artery and the CCA. III. The last to remove is the clip from the ICA. IV. Direct dopplerometry is used to
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