1、Human appendectomy (rabbit processus vermiformis),人阑尾（兔蚓突）切除术,李宁 LI NING 小儿外科 Pediatric Surgery Department,Company Logo,一、人阑尾切除术 Human appendectomy,Company Logo,Anatomy of Appendix,The location of the base is constant, whereas the position of the tip of the appendix varies. The tip can be at any poi
2、nt on a 360-degree circle around the base of the cecum. Thus, the site of maximal pain and tenderness of appendicitis can vary.,Company Logo,The blood supply is from the appendicular artery, which is the branch of the ileocolic artery originating from the superior mesenteric artery.,Anatomy of Appen
3、dix,Company Logo,Incision,A: Classic incision Right-lower quadrant incision over the McBurney point (2/3 of the distance between the umbilicus and the anterior superior iliac spine). B: Exploratory incision Trans-rectus incision.,Company Logo,Incision,Company Logo,Layers traversed,Skin Subcutaneous
4、fat Scarpas fascia External oblique aponeurosis Internal oblique muscle Transversus abdominus muscle Transversalis fascia Pre-peritonieal fat Parietal peritoneum,Company Logo,Decollement,Divide the subcutaneous fat and fascia down to the external oblique aponeurosis. Use retractors to fully expose t
5、he external oblique aponeurosis and then make a small incision with the scalpel into the external oblique aponeurosis along the line of fibres extend this with tissue scissors.,Company Logo,Decollement,The internal oblique muscle has now been exposed. Bluntly split this and the underlying transversu
6、s abdominus with scissors (large curved work well) or fingers to reveal the peritoneum.,Company Logo,Using clamps hold the peritoneal layer up, tenting it off underlying structures. Open the peritoneum at the apex of this tent by gently stroking the belly of the scalpel across. Take care not to dama
7、ge bowel beneath. Extend the incision with scissors.,Cut open the peritoneum,Company Logo,In order to protect the wound from infection by pus from the appendix, skin and subcutaneous tissues must be isolated. 1. Skin and small drapes are clamped together with Towel clips 2. Peritoneum and sponge mat
8、s are clamped together with Allis clamps,Wound protection,Company Logo,Search and exposure of appendix,Retractors are placed into the peritoneum, and the cecum is identified and partially exteriorized, using a moist gauze pad. The taenia coli is followed to the point where it converges with the othe
9、r taenia, leading to the base of the appendix. The appendix is brought into the field of vision.,Company Logo,Inspection,Inspect the appendix and confirm your diagnosis.,Company Logo,Skeletization,Cutting of the mesoappendix and ligation of the appendicular artery The mesoappendix is cut between Kel
10、ly clamps in several steps (clampingcuttingligating),Company Logo,Ligation of the base,The base of the appendix is crushed with a straight clamp, and then ligated with a 0 thread.,Company Logo,Purse-string suture,A seromuscular, purse-string suture is placed around the stump of the appendix, using 3
11、 or 40 thread, with a round-bodied needle. Care should be taken as to the depth of the stitches: if they are too deep, the infected bowel content can pass into the abdominal cavity; if they are too superficial, they can be torn out.,Company Logo,Excision,The appendix is clamped with a straight clamp
12、 distal to the crushed line and cut above the base tie, just below the straight clamp The scalpel and the appendix should be thrown into a bowl The stump of the appendix is disinfected with iodophor,Company Logo,Bury the stump,The stump of the appendix is buried (the stump will be inverted in the lu
13、men of the intestine), and the purse-string suture is then tied. If it failed to bury the stump. The appendix stump is then covered with a serosa layer with an “8” stitch.,Company Logo,Prepare to closure,The cecum and appendiceal stump are then placed back into the abdomen. If free perforation is en
14、countered, thorough irrigation of the abdomen with warm saline solution and drainage of any obvious cavity and well-developed abscesses is required.,Company Logo,Closure of abdominal wall,The peritoneum is identified, and closed with a simple continuous 2 or 30 suture.,缝合腹膜,Company Logo,Closure of a
15、bdominal wall,The inferior oblique muscles are re-approximated with a simple interrupted 0 to 30 suture, and the external oblique fascia is closed with an interrupted 20 suture. The skin is closed with an interrupted 2 to 40 suture.,Company Logo,二、兔蚓突切除术 Resection of rabbit processus vermiformis,Com
16、pany Logo,Group together in fours Operator, first assistant, anaesthetist, scrub nurse Operators, first assistants, scrub nurses go to change scrub clothes Operators and anaesthetists go to catch the rabbit and perform anesthesia. First assistants go to scrub and disinfect the skin and draping. Scru
17、b nurses go to scrub and put on gown and gloves.,Company Logo,Procedure,Company Logo,SEE VIDEO,Company Logo,Pay attention to aseptic principle Wear caps and masks,Company Logo,Anesthesia record,Fill the patients information Record the pulse (temporal Arteries, common carotid artery, heart beat) and
18、breath (chest fluctuate) every 15 minutes Record the time of every special step, such as the insicion, unexpected bleeding, replenishing anaesthetic, transection of appendix, closure, and so on.,Company Logo,Pay attention to aseptic principle Practise basic skills Team work,Company Logo,Operation record,Anaesthesia and position Incision and decollement Describing the pathological changes Operation procedure in detail. Others: Send the patient back to the ward. Send the appendix for histology. Record the total blood loss.,Thank You !,李宁 LI NING 小儿外科 Pediatric Surgery Department,
