cea手術(shù)室篇-閱讀頁
2024-10-04 05:14本頁面
【正文】 residual frills is tested by flushing and careful excision. 第四十三頁，共六十一頁。 斑塊切斷順序： The plaque is transversally cut in the most caudal aspect of the arteriotomy. the arteriotomy proceeds cranially stepwise always after the segment of the plaque is dissected free. 第四十四頁，共六十一頁。 ICA斑塊殘端的處理： Technique to secure the distal end of the plaque. In case it is not possible to remove all remnants of plaque in the distal end of ICA and the intima is loose, tacking sutures are used. The stitches are positioned at 6, 9 and 12 hours “l(fā)ooking into ICA lumen〞 . The 4th firm point is the first stitch starting the closure (at 3 hours). RP Residual plaque 6/0 tacking sutures 第四十六頁，共六十一頁。 Residual clot is flushed away. 第四十七頁，共六十一頁。 III. Before its pletion, the ICA is shortly opened and flushed. The artery is flushed with heparin solution。 肝素鹽水沖洗： As the suture line is almost plete, further flooding of the segment with heparinized saline solution is undertaken to remove any residual debris and to fill the segment with fluid, removing any air bubbles. 短暫松開甲狀腺上 A： The loop may be released around the superior thyroid artery to allow blood to fill thesegment, flushing out any remaining bubbles. The internal carotid artery clamp is removed first to ensure that there are no leaks, then the external. 第四十九頁，共六十一頁。 臨時阻斷夾釋放順序 第五十頁，共六十一頁。 Covered by a small strip of oxycellulose。 Closed in two layers (platysma, skin) 縫合后滲血的處理 第五十一頁，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。 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 第五十七頁，共六十一頁。 ? Believe me, I can...... ? We are sure, we can…… 第五十九頁，共六十一頁。 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)。 Cranial nerve injury: XIIth, VIIth, recurrent nerve 第六十一頁，共六十一頁
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