医学精品课件：Splenectomy2.ppt

1、Splenectomy Debridement,Learning objectives,To understand the principles of splenectomy and its potential complications.,Splenectomy,Splenectomy,Anatomy,It lies in the left hypochondrium between gastric fundus and left hemidiaphragm. The hilus sits in the angle between stomach and kidney and is in c

2、ontact with the tail of pancreas.,The splenic artery arises from the coeliac axis and runs along the upper border of the body and tail of the pancreas, to which it gives small branches.,Anatomy,Splenectomy,The short gastric and left gastroepiploic braches pass between the layers of the gastrosplenic

3、 lig. The vein runs behind the pancreas and join the superior mesenteric vein to form the portal vein.,Splenectomy,Anatomy,Gastrolienal lig. Lienorenal lig. Phrenicosplentic lig. Lienocolic lig.,Trauma Portal hypertension Variceal surgery Haematological Spherocytosis Purpura Hypersplenism Oncologica

4、l,Indications for splenectomy,Splenectomy,Incision an upper midline incision a left subcostal incision a thoracoabdominal incision for a giant spleen,Technique of open splenectomy,Splenectomy,adherent to the diaphragm,Technique of open splenectomy,Splenectomy,Cut open the skin, muscles and peritoneu

5、m, find the stomach. Open up the gastrosplenic ligament, the short gastric vessels and left gastroepiploic vessels are ligated and divided . Divide the lienorenal ligament with long curved scissors and find the spleen artery. Ligate the spleen artery primarily to prevent blood loss and reduce the si

6、ze of the spleen.,Technique of open splenectomy,Splenectomy,Rotate the spleen to ligate and divide the lienocolic ligament. Blunt dissection of the phrenicosplentic ligament. Move the spleen out of the incision by hands and insert a pack behind the spleen.,Technique of open splenectomy,Splenectomy,R

7、otate the spleen along with the tail and body of the pancreas. Separate the pancreas from the spleen by ligating and dividing the hilar vessels. It is vital to use three clamps and cut the pedical near the distal clamp. Remove the spleen and double ligate the pedical. Make a figure of 8 suture dista

8、l.,Splenectomy,Incision Dividing ligaments Cutting and ligating the pedical Closure the incision,Technique of open splenectomy,Postoperative complications,Splenectomy,Immediate complications include hemorrhage resulting from a slipped ligature from the splenic artery. Damage to the tail of the pancr

9、eas may result in pancreatitis. The blood platelet count may rise and aspirin may be recommended to prevent venous thrombosis.,Postoperative complications,Splenectomy,Opportunist post-splenectomy infection (OPSI) The risk is greater in the young patient, in patient who have undergone splenectomy for

10、 sickle cell disease and autoimmune anaemia or thrombocytopenia. The benefit of prophylactic antibiotics is controversial. Suspected infection can be treated intravenouly.,Spleen of the rabbit,Splenectomy,Thank you!,Debridement,清创缝合术,Debridement is the surgical removal of dead, damaged, or infected

11、tissue to improve the healing. Efficient debridement is essential in treating all wounds. Debridment reduces wound contamination, further tissue destruction, and dead spaces that harbour bacterial growth, and will allow healthy granulation tissue to form.,What is debridement?,清创缝合术,Principles of deb

12、ridement,Cleaning (wash) Debridement (trim) Reconstruction (surture),清创缝合术,Cleaning of the wound,Cover the wound with a size-suitable sterilized dressing. Scrubbing the skin with a nail brush dipped in liquid soap to remove most contaminants around the wound. Rinse off the skin with saline till clea

13、n. Remove the dressing and clean the wound by turns of irrigation with hydrogen peroxide and saline until the wound is thoroughly clean.,清创缝合术,Debridement of the wound,First assistant disinfect the injured skin with iodophor and following of draping. Remove the contaminated skin by tissue scissor, o

14、nly a minimal amount of skin edge should be excised around the wound. Remove the foreign matter. Dead muscle that does not bleed or contract or has an unhealthy color must be excised .,清创缝合术,Debridement of the wound,Haemostasis should be secures with the aid of hot packs and ligation. Major artery a

15、nd vein damage must be noted. The ends should be trimmed and sutured when possible. The majority of nerve injuries are neuropraxias and do recover. The wound should be irrigated thoroughly with saline again.,清创缝合术,Suture of the wound,Close the muscle by interrupted suture, leaving no dead space. The skin could be primary closed within 8 hours after injury, which indicates a contaminated wound. Otherwise, the wound has probably developed infection and should be left open with a view to delayed primary closure at 4-6 days. Prescribe the tetanus vaccination.,Thank you！,