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详解各种外科缝合法,图文并茂!

2016-06-01 医学之声 医学之声

各种外科手术的缝合方法是怎样的?

1单纯缝合法

使切口创缘的两侧直接对合的一类缝合方法,如皮肤缝合。

⑴、单纯间断缝合:操作简单,应用最多,每缝一针单独打结,多用在皮肤、皮下组织、肌肉、腱膜的缝合,尤其适用于有感染的创口缝合。

单纯间断缝合
 
⑵、连续缝合法:在第一针缝合后打结,继而用该缝线缝合整个创口,结束前的一针,将重线尾拉出留在对侧,形成双线与重线尾打结。

连续缝合法

⑶、连续锁边缝合法:操作省时,止血效果好,缝合过程中每次将线交错,多用于胃肠道断端的关闭,皮肤移植时的缝合。

连续锁边缝合法
 
⑷、8字缝合:由两个间断缝合组成,缝扎牢固省时,如筋膜的缝合。


两种8字缝合法

⑸、贯穿缝合法:也称缝扎法或缝合止血法,此法多用于钳夹的组织较多,单纯结扎有困难或线结容易脱落时。

2内翻缝合法

使创缘部分组织内翻,外面保持平滑。如胃肠道吻合和膀胱的缝合。

⑴、间断垂直褥式内翻缝合法:又称伦孛特(Lembert)缝合法,常用于胃肠道吻合时缝合浆肌层。

间断垂直褥式内翻缝合法
 
⑵、间断水平褥式内翻缝合法:又称何尔斯得(Halsted)缝合法,多用于胃肠道浆肌层缝合。

间断水平褥式内翻缝合法

⑶、连续水平褥式浆肌层内翻缝合法:又称库兴氏( Cushing )缝合法,如胃肠道浆肌层缝合。

连续水平褥式浆肌层内翻缝合法
 
⑷、连续全层水平褥式内翻缝合法:又称康乃尔( Connells)缝合法,如胃肠道全层缝合。

连续水平褥式全层内翻缝合法

⑸、荷包缝合法:在组织表面以环形连续缝合一周,结扎时将中心内翻包埋,表面光滑,有利于愈合。常用于胃肠道小切口或针眼的关闭、阑尾残端的包埋、造瘘管在器官的固定等。

荷包缝合
 
⑹、半荷包缝合法:常用于十二指肠残角部、胃残端角部的包埋内翻等。

半荷包缝合(十二指肠残端下角包埋)

3外翻缝合法

使创缘外翻,被缝合或吻合的空腔之内面保持光滑,如血管的缝合或吻合。

⑴、间断垂直褥式外翻缝合法:如松驰皮肤的缝合。

间断垂直褥式外翻缝合法
 
⑵、间断水平褥式外翻缝合法:如皮肤缝合。

间断水平褥式外翻缝合法

⑶、连续水平褥式外翻缝合法:多用于血管壁吻合。

连续水平褥式外翻缝合法

4减张缝合法

对于缝合处组织张力大,全身情况较差时,为防止切口裂开可采用此法,主要用于腹壁切口的减张。缝合线选用较粗的丝线或不锈钢丝,在距离创缘2-2.5cm处进针,经过腹直肌后鞘与腹膜之间均由腹内向皮外出针,以保层次的准确性,亦可避免损伤脏器。缝合间距离3-4cm,所缝合的腹直肌鞘或筋膜应较皮肤稍宽。使其承受更多的切口张力,结扎前将缝线穿过一段橡皮管或纱布做的枕垫,以防皮肤被割裂,结扎时切勿过紧,以免影响血运。

减张缝合法

5皮内缝合法

可分为皮内间断及皮内连续缝合两种,皮内缝合应用眼科小三角针、小持针钳及0号丝线。缝合要领:从切口的一端进针,然后交替经过两侧切口边缘的皮内穿过,一直缝到切口的另一端穿出,最后抽紧,两端可作蝴蝶结或纱布小球垫。常用于外露皮肤切口的缝合,如颈部甲状腺手术切口。其缝合的好坏与皮下组织缝合的密度、层次对合有关。如切口张力大,皮下缝合对拢欠佳,不应采用此法。此法缝合的优点是对合好,拆线早,愈合疤痕小,美观。

皮内间断缝合

皮内连续缝合

随着科学技术的不断发展,除缝合法外,尚有其他的一些闭合创口的方法,如吻合器,封闭器,医用粘胶,皮肤拉链等。

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    2017-09-05 jyf701

    nice

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=240814, encodeId=5a7e24081439, content=nice, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=464f1743154, createdName=jyf701, createdTime=Tue Sep 05 21:48:23 CST 2017, time=2017-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=90311, encodeId=4358903117a, content=值得学习的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=169, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEIsrUxHnicsiaqwzJibCks60HOicbEAgbNzUiciboMJDzsWg16OHTeNHhyYvTg6TDXTlOx7icnhttCYYe2ujYt0yND7dYusOsibl9XnQCE/0, createdBy=7ad21722200, createdName=jaysppr, createdTime=Sat Jun 18 02:11:00 CST 2016, time=2016-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=90312, encodeId=28c59031231, content=我是外科的研究生,能学到很多东西, beContent=null, objectType=article, channel=null, level=null, likeNumber=182, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEIsrUxHnicsiaqwzJibCks60HOicbEAgbNzUiciboMJDzsWg16OHTeNHhyYvTg6TDXTlOx7icnhttCYYe2ujYt0yND7dYusOsibl9XnQCE/0, createdBy=7ad21722200, createdName=jaysppr, createdTime=Sat Jun 18 02:11:00 CST 2016, time=2016-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=88012, encodeId=dbe388012cf, content=好好学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=53751677671, createdName=沉心多思, createdTime=Wed Jun 01 15:21:00 CST 2016, time=2016-06-01, status=1, ipAttribution=)]
    2016-06-18 jaysppr

    值得学习的文章

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=240814, encodeId=5a7e24081439, content=nice, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=464f1743154, createdName=jyf701, createdTime=Tue Sep 05 21:48:23 CST 2017, time=2017-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=90311, encodeId=4358903117a, content=值得学习的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=169, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEIsrUxHnicsiaqwzJibCks60HOicbEAgbNzUiciboMJDzsWg16OHTeNHhyYvTg6TDXTlOx7icnhttCYYe2ujYt0yND7dYusOsibl9XnQCE/0, createdBy=7ad21722200, createdName=jaysppr, createdTime=Sat Jun 18 02:11:00 CST 2016, time=2016-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=90312, encodeId=28c59031231, content=我是外科的研究生,能学到很多东西, beContent=null, objectType=article, channel=null, level=null, likeNumber=182, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEIsrUxHnicsiaqwzJibCks60HOicbEAgbNzUiciboMJDzsWg16OHTeNHhyYvTg6TDXTlOx7icnhttCYYe2ujYt0yND7dYusOsibl9XnQCE/0, createdBy=7ad21722200, createdName=jaysppr, createdTime=Sat Jun 18 02:11:00 CST 2016, time=2016-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=88012, encodeId=dbe388012cf, content=好好学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=53751677671, createdName=沉心多思, createdTime=Wed Jun 01 15:21:00 CST 2016, time=2016-06-01, status=1, ipAttribution=)]
    2016-06-18 jaysppr

    我是外科的研究生,能学到很多东西

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=240814, encodeId=5a7e24081439, content=nice, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=464f1743154, createdName=jyf701, createdTime=Tue Sep 05 21:48:23 CST 2017, time=2017-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=90311, encodeId=4358903117a, content=值得学习的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=169, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEIsrUxHnicsiaqwzJibCks60HOicbEAgbNzUiciboMJDzsWg16OHTeNHhyYvTg6TDXTlOx7icnhttCYYe2ujYt0yND7dYusOsibl9XnQCE/0, createdBy=7ad21722200, createdName=jaysppr, createdTime=Sat Jun 18 02:11:00 CST 2016, time=2016-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=90312, encodeId=28c59031231, content=我是外科的研究生,能学到很多东西, beContent=null, objectType=article, channel=null, level=null, likeNumber=182, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEIsrUxHnicsiaqwzJibCks60HOicbEAgbNzUiciboMJDzsWg16OHTeNHhyYvTg6TDXTlOx7icnhttCYYe2ujYt0yND7dYusOsibl9XnQCE/0, createdBy=7ad21722200, createdName=jaysppr, createdTime=Sat Jun 18 02:11:00 CST 2016, time=2016-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=88012, encodeId=dbe388012cf, content=好好学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=53751677671, createdName=沉心多思, createdTime=Wed Jun 01 15:21:00 CST 2016, time=2016-06-01, status=1, ipAttribution=)]
    2016-06-01 沉心多思

    好好学习了

    0

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