【正文】
CA, the superior thyroid artery and the CCA. III. The last to remove is the clip from the ICA. IV. Direct dopplerometry is used to check the patency and disclose any irregularities in the vessels。 臨時阻斷夾釋放順序 第五十頁,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。 Covered by a small strip of oxycellulose。 ? suction drain ? Carotid sheath。 Closed in two layers (platysma, skin) 縫合后滲血的處理 第五十一頁,共六十一頁。 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。 相關(guān)并發(fā)癥 ? Carrdiac issues: The two possible serious plications likely to occur are myocardial infarction or cardiac failure during the perioperative period and a decrease in blood pressure during the perioperative period. ? Ipsilateral stroke: drop in blood pressure, vessel thrombosis or by embolisation, from the endarterectomised vessel. ? Hyperperfusion syndrome ? Cranial nerve injury: XIIth, VIIth, recurrent nerve ? Wound: wound haematoma and excessive wound swelling 第五十三頁,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。 作為術(shù)者參與手術(shù) 第五十五頁,共六十一頁。 術(shù)中解剖演示 第五十六頁,共六十一頁。 術(shù)中解剖演示 第五十七頁,共六十一頁。 We are A Team 第五十八頁,共六十一頁。 ? Believe me, I can...... ? We are sure, we can…… 第五十九頁,共六十一頁。 您的聆聽 第六十頁,共六十一頁。 內(nèi)容總結(jié) 手術(shù)室中的頸動脈內(nèi)膜切除術(shù) Carotid Endarterectomy(CEA)。 the CCA, C window aneurysm clip at the ICA, P plaque, T superior thyroid artery。 Cranial nerve injury: XIIth, VIIth, recurrent nerve 第六十一頁,共六十一頁。