上呼吸道外科手术中英培训ppt课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。,Introduction,前言,Anatomy & Physiology of the upper airways (nose,throat, trachea/bronchi),上呼吸道解剖,&,生理（鼻子、喉部、气管,/,细支气管）,Brachycephalic Obstructive Airway Syndrome,短头颅气道阻塞综合征,Temporary tracheostomy,临时气管切开术,Introduction 前言Anatomy & Phys,1,Anatomy & Physiology 1,解剖学,&,生理学,1,Pharynx,咽部,Fibromuscular tube that serves as a conduit for both the respiratory and the digestive tract,纤维肌性的管道，同时作为呼吸道和消化道,Evans H.E. and Christensen G.C. Anatomy of the DOG, 2,nd,edition, 1993; The Respiratory Apparatus, fig 8-9, page 517,Anatomy & Physiology 1解剖,2,Anatomy & Physiology 2,解剖学,&,生理学,2,Pharynx,咽部,Nasopharynx,鼻咽,Oropharynx,口咽,Laryngopharynx,咽喉,Evans H.E. and Christensen G.C. Anatomy of the DOG, 2,nd,edition, 1993; The Respiratory Apparatus, fig 8-9, page 517,Anatomy & Physiology 2解剖,3,Anatomy & Physiology 1,解剖学,&,生理学,Oropharynx,口咽部,Bounded laterally by the palatoglossal and palatopharyngeal arches, and caudally by the tip of the epiglottis,侧面以腭舌弓和腭咽弓为界，喉部为会厌尖部,Anatomy & Physiology 1,4,Anatomy & Physiology 6,解剖学,&,生理学,6,Tonsils,扁桃体,Thin lymph node located bilaterally in the lateral wall of the oropharynx, just caudal to the palatoglossal fold,薄淋巴结位于口咽部两边侧壁上，腭舌皱襞的后方,No afferent lymphatics,没有输入淋巴结,Efferent vessels drain in retropharyngeal Ln,出球小动脉流入咽后,Ln,Anatomy & Physiology 6,5,Anatomy & Physiology 7,解剖学,&,生理学,7,Tonsils,扁桃体,Located in tonsillar crypt or fossa and covered by tonsillar fold in dogs,犬：位于扁桃腺隐窝，由扁桃体褶覆盖,Cats: tonsil is very small and not covered by a mucosal fold,猫：扁桃体很小，没有被扁桃体褶覆盖,Anatomy & Physiology 7解,6,Physiology,生理学,Pharynx,咽,Swallowing (deglutition),吞咽,Physiological phenomenon that occurs many times daily,生理现象，每天都会发生很多次,May be initiated voluntary, but most swallows occur subconsciously between meals, about once a minute in awake individuals,会主动发生，但大多数吞咽会潜意识地发生在餐间，清醒个体每分钟会吞咽一次,Driven by salivation, which stimulates the sensory receptors in the mouth and pharynx,由唾液驱使，会刺激口腔和咽部的感觉受体,Salivation & swallowing cease during sleep,唾液以及吞咽在睡眠时会停止,Physiology生理学Pharynx 咽,7,Physiology,生理学,Pharynx,咽部,Swallowing (deglutition),吞咽,Oral preparatory phase,口腔准备期,Oral phase,口期,Pharyngeal phase,咽喉期,Esophageal phase,食道期,Physiology生理学Pharynx 咽部,8,Anatomy & Physiology 8,解剖学,&,生理学,8,Hedlund C.S. Atlas of Small Animal Ear-, Nose-, and Throat-Diseases, 2002,Anatomy & Physiology 8解剖学&生理学,9,Physiology,生理学,Larynx,喉部,Regulation of air flow,调节气流,Coughing,咳嗽,A reflex evoked by stimulation of,“,cough receptors,”,working as a clearing mechanism to protect the lower airway,由“咳嗽受体”的刺激诱发的反射，是一种保护下呼吸道的清洁机制,Vocalization,发音,Physiology生理学Larynx 喉部,10,Cough receptors,咳嗽受体,Sensory receptors responding to:,感觉受体，对如下刺激有反射：,Airway pressure,气道压,Vocal fold motion,生襞运动,Tactile stimuli,触觉刺激,Chemical stimuli,化学刺激,Variable threshold,可变化的阈值,Mucosa of the,黏膜,Larynx,喉部,Trachea,气管,Carina,支气管,Bronchi,细支气管,Cough receptors 咳嗽受体Sensory r,11,Diagnosis,诊断,History,病史,Patient,患病动物,Clinical signs,临床症状,Dyspnea, stridor, dysphonia, dysphagia and salivation!,呼吸困难、喘鸣、发声困难、咽下困难、分泌唾液,Diagnosis 诊断History 病史,12,Physical examination,身体检查,General examination,一般检查,Examination of respiratory system,呼吸系统检查,Upper respiratory tract,上呼吸道,Lower respiratory tract,下呼吸道,Examination of cardiovascular system,心血管系统检查,Physical examination身体检查Ge,13,Diagnosis,诊断,Pharyngo-Laryngoscopy!,咽喉镜检查,Throat inspection with laryngoscope,检喉镜进行喉部探查,Nasopharyngoscopy,鼻咽镜检查,Diagnostic Imaging,诊断图像,Electromyography,肌电图学,Diagnosis 诊断Pharyngo-Laryngos,14,Diagnosis,诊断,Laryngoscopy!,喉镜检查,Diagnosis 诊断Laryngoscopy! 喉镜,15,Intubation,插管,Laryngoscopy!,喉镜检查,Intubation 插管Laryngoscopy! 喉,16,Intubation,插管,Laryngoscopy!,喉镜检查,Intubation 插管Laryngoscopy! 喉,17,Diagnosis,诊断,Diagnostic Imaging,诊断影像,Videofluoroscopy,电视透镜检查,Radiography,放射线照相,Ultrasonography,超声波检查,CT-scan / MRI,CT,扫描,/MRI,Diagnosis 诊断Diagnostic Imagin,18,Diagnosis,诊断,Laryngoscopy!,喉镜检查！,Diagnostic Imaging,诊断图像,Radiography,放射线照相术,Diagnosis 诊断Laryngoscopy! 喉镜,19,Diagnosis,诊断,Laryngoscopy!,喉镜检查！,Diagnostic Imaging,诊断图像,Radiography,放射线照相,Ultrasonography,超声波,CT-scan / MRI,CT,扫描,/MRI,Electromyography,肌电图,Diagnosis 诊断Laryngoscopy!,20,Introduction,简介,Brachycephalic Obstructive (Airway) Syndrome,短头颈气道阻塞综合征,History/Signalment,病史,/,特征描述,Etiopathogenesis & Symptoms,发病机理和症状,Diagnostic Procedures,诊断程序,Current treatment options,当前治疗方法,Management & Breeding program,管理,&,品种计划,Introduction 简介 Brachycephalic,21,BOS History/SignalmentBOS,历史,/,特征,Brachycephalic breeds,短头颅品种,Upper airway obstruction,上呼吸道阻塞,Bones of the skull grow to a normal width but reduced length,头骨宽度正常但是长度较短,Soft tissues not proportionally reduced, are even redundant,软组织没有适当减少，甚至非常多,BOS History/SignalmentBOS历史/,22,BOS EtiopathogenesisBOS,发病机理,Stenotic nares,狭窄的鼻孔,Elongated soft palate,狭长的软腭,Eversion of laryngeal saccule (laryngeal collaps),喉囊翻转（喉头塌陷）,Tracheal hypoplasia (E Bulldog),气管发育不全（英国斗牛犬）,BOS EtiopathogenesisBOS,23,BOS = HYPOPLASIA BOS=,发育不全,Nasal hypoplasia,鼻腔发育不全,Stenotic nares, turbinate protrusion,鼻孔狭窄，鼻甲骨前突,Pharyngeal hypoplasia,咽部发育不全,Overlong soft palate, chronic inflammation, edema, tonsillar abnormalities,软腭过长、慢性炎症、水肿、扁桃体异常,Laryngeal hypoplasia,喉发育不全,Inflammation, eversion ventricles: Collapse,炎症、喉室外翻：塌陷,Tracheal hypoplasia,气管发育不全,BOS = HYPOPLASIA BOS=发育不,24,BOS SymptomsBOS,症状,Mild to severe dyspnea,中度至严重的呼吸困难,Obstructive (later restrictive),阻塞物（后限制性）,STRIDOR,喘鸣,Nasal,鼻音,Nasopharyngeal,鼻咽,Pharyngeal (stertor),喉音（打鼾）,Laryngeal,喉部,Tracheal,气管,BOS SymptomsBOS症状Mild to seve,25,BOS Symptoms,症状,Exercise intolerance,运动障碍,Mouth breathing,张口呼吸,Gagging,恶心,Cyanosis and collapse,发绀或晕倒,Signs worsen with excitement, stress and increased heat and humidity,兴奋、压力大、高温、湿度增大时症状加重,Progression of clinical signs with time,症状随时间不断加剧,BOS Symptoms 症状Exercise intol,26,BOS Physical ExamBOS,身体检查,General examination,一般检查,LISTEN! TEMPERATURE!,听！体温！,Examination of respiratory system,呼吸系统检查,Upper respiratory tract,上呼吸道,Lower respiratory tract,下呼吸道,Examination of cardiovascular system,心血管系统检查,BOS Physical ExamBOS身体检查Gen,27,BOS DiagnosisBOS,诊断,History,病史,Symptoms,症状,Physical examination,体检,Radiography/CT neck & thoracic cavity,射线照相,/CT,进行颈部和胸腔的检查,Endoscopic respiratory tract examination (and gastrointestinal tract examination),内窥镜呼吸道检查（以及胃肠道检查）,BOS DiagnosisBOS诊断History,28,CT-scan skull CT,扫描头骨, Leipzig),CT-scan skull CT扫描头骨htt,29,CT-scan BOS,Grand Journal of Small Animal Practice (2011) 52, 232239,CT-scan BOSGrand & Burea,30,Endoscopy BOS BOS,内窥镜检查,Endoscopy,内窥镜检查,Inspection of mouth and throat under general anaesthesia with dental probing,全麻状态下用牙科探针探查口腔和喉部,Rigid endoscopy,硬式内窥镜,Nasal sinuses, pharynx/larynx, trachea/bronchi,鼻窦、咽,/,喉、气管,/,细支气管,Flexible endoscopy,软式内窥镜,Nasopharynx,鼻咽部,Endoscopy BOS BOS内窥镜检查,31,Throat inspection 喉部探查,Throat inspection 喉部探查,32,Patient 1,病例,1,Pug, , 3 years old,巴哥犬，雄性，,3,岁,Dyspnea with sniffing stridor,呼吸困难，伴有尖锐的喘鸣声,What is your,Anatomical diagnosis ?,你的解剖学诊断是什么？,Differential diagnosis ?,鉴别诊断是什么？,Patient 1 病例1Pug, , 3 years,33,Patient 1,病例,1,Anatomical diagnosis?,解剖学诊断？,Nose, nasal sinuses,鼻子、鼻窦,Differential diagnosis?,鉴别诊断？,BOS; nasal component BOS,；鼻附属结构,Stenotic nares,鼻孔狭窄,Turbinate protrusion,鼻甲骨突出,Nasopharyngeal tumor, FB, abscess, etc,鼻咽肿瘤、,FB,、脓肿等,Patient 1 病例1Anatomical diagno,34,BOS: stenotic nares BOS,：鼻孔狭窄,BOS: stenotic nares BOS：鼻孔狭窄,35,CT-scan skull CT,头骨扫描, Leipzig),CT-scan skull CT头骨扫描htt,36,CT-scan BOS CT,扫描, Leipzig),CT-scan BOS CT扫描http:/,37,Patient 1,Treatment,治疗,Resection stenotic nares,切除狭窄的鼻孔,LASER resection turbinates,激光切除鼻甲,Correct other abnormalities,纠正其他异常,Patient 1Treatment 治疗,38,Resection stenotic nares,切除狭窄的鼻孔,Resection stenotic nare,39,40,Resection stenotic nares,切除狭窄的鼻孔,40 Resection stenotic nar,40,Resection stenotic nares,切除狭窄的鼻孔,Resection stenotic nares,41,Resection stenotic nares,切除狭窄的鼻孔,Resection stenotic nares,42,Resection stenotic nares,切除狭窄的鼻孔,Resection stenotic nares,43,Resection turbinates,切除鼻甲,Resection turbinates切除鼻甲,44,CT-scan BOSCT,扫描,CT-scan BOSCT扫描,45,Patient 2,病例,2,French Bulldog, , 3 years old,法国斗牛犬，雄性、,3,岁,Dyspnea with stridor,呼吸困难伴随喘鸣声,What is your,Anatomical diagnosis ?,你的解剖学诊断？,Differential diagnosis ?,鉴别诊断？,Patient 2 病例2French Bulldog,46,Patient 2,病例,2,Anatomical diagnosis?,解剖学诊断？,Pharynx,咽部,Differential diagnosis?,鉴别诊断？,BOS; pharyngeal hypoplasia BOS,；咽部发育不全,Overlong soft palate,狭长的软腭,Broad, thickened, flaccid soft palate,软腭宽、厚而且无力,Pharyngeal tumor, FB, abscess etc.,咽部肿瘤、,FB,、脓肿等,Patient 2 病例2Anatomical diagn,47,Patient 2,病例,2,Diagnostic Work-up?,诊断检查？,Pharyngoscopy,咽镜检查,Radiography neck and thorax,颈部、胸部射线照相检查,CT,Patient 2 病例2Diagnostic Work-,48,上呼吸道外科手术中英培训ppt课件,49,50,BOS: overlong soft palate,软腭过长,50 BOS: overlong soft pa,50,上呼吸道外科手术中英培训ppt课件,51,上呼吸道外科手术中英培训ppt课件,52,Patient 3,病例,3,English Bulldog, 11 months,英国斗牛犬，雄性，,11,个月,Progressive dyspnea with stridor,呼吸困难不断发展，且伴有喘鸣声,Patient 3 病例3English Bulldog,53,Patient 3,病例,3,Anatomical diagnosis,解剖学诊断,Larynx / trachea,喉头,/,气管,Differential diagnosis,鉴别诊断,BOS; laryngeal collapse BOS,； 喉部塌陷,Laryngeal stenosis, FB, paralysis,喉部狭窄、,FB,、麻痹,Laryngeal tumor,喉部肿瘤,Patient 3 病例3Anatomical diagn,54,Patient 3,病例,3,Work up ?,确诊？,Radiography (neck and thoracic cavity),射线照相检查（颈部和胸腔）,Pharyngo-laryngoscopy,咽喉镜检查,Patient 3 病例3Work up ? 确诊？,55,Radiography thorax胸部射线照相,Radiography thorax胸部射线照相,56,BOS- Screening,BOS- Screening,57,Tracheal hypoplasia,气管发育不全,Symtomatic,症状,Weight reduction,体重减轻,AB,Antitussives,止咳,Corticosteroids,皮质类固醇,Correction of other abnormalities,纠正其他异常,Euthanasia,安乐死,Tracheal hypoplasia气管发育不全Symt,58,BOS vs Normal LarynxBOS,与正常喉部对比,BOS vs Normal LarynxBOS与正常喉部对,59,BOS: Patient 3,病例,3,BOS: Patient 3 病例3,60,BOS: laryngeal hypoplasia,喉发育不全,BOS: laryngeal hypoplasi,61,BOS: Laryngeal collapse,喉部塌陷,From Slatter D. Textbook of Small Animal Surgery, 3,rd,edition, 2003, figure 50-5 page 811 (Monnet E),BOS: Laryngeal collapse喉部,62,BOS: laryngeal collapse,喉部塌陷,BOS: laryngeal collapse喉部,63,BOS: Laryngeal collapse I,喉部塌陷,1,Fossum T.W. Small Animal Surgery, 2,nd,edition, 2002, fig 30-11, page 733,BOS: Laryngeal collapse,64,Laryngeal collapse,喉部塌陷,Grade I 1,级,Resection of stenotic nares / soft palate,切除狭窄的鼻孔,/,软腭,Resection of laryngeal saccules,喉囊切除,Grade II 2,级,Resection of stenotic nares / soft palate,切除狭窄的鼻孔,/,软腭,Resection of laryngeal saccules,喉囊切除,Partial arytenochordectomy (?),部分声带切除术（？）,Grade III: 3,级,Partial laryngectomy or lateralization: ?,喉部分切除术或单侧切除？,Permanent tracheostomy (?),永久性气管造口术（？）,Euthanasia,安乐死,Laryngeal collapse喉部塌陷Grade I,65,Temporary Tracheotomy 1,暂时性气管切开术,1,Indications,适应症,Upper Airway Obstruction,上呼吸道阻塞,Nose,鼻子,Larynx,喉,Trachea; rostral to stoma!,气管；,气孔,Alternative route for intubation in case of laryngeal surgery,在喉部手术时作为插管替代方法,To prevent postoperative dyspnea after surgery of the pharynx or larynx,咽或喉的手术后要避免术后的呼吸困难,Temporary Tracheotomy 1暂,66,Temporary Tracheotomy 2,暂时性气管切开术,2,Cave!,洞,EVERY TRACHEOTOMY,STARTS WITH,INTUBATION !,每一个气管切开术都是由插管开始的！,Temporary Tracheotomy 2暂,67,Temporary Tracheotomy 3,暂时性气管切开术,3,Surgery,外科,Dorsal recumbency with elevation of neck,仰卧保定，抬高颈部,Perpendicular incision to the midline of 2 cm, halfway between larynx and thoracic inlet,在喉部和胸腔入口之间的一半距离处，沿中线切开,2cm,切口,Blunt dissection of subcutis and M. sternohyoideus in the midline,钝性分离中线上的皮下组织和胸骨舌骨肌,Avoid tracheal blood supply and important nerves,避开气道供血血管和重要神经,Temporary Tracheotomy 3暂,68,Anatomy & Physiology,解剖学和生理学,Thyroid arteries,甲状腺动脉,Recurrent laryngeal and vagus nerves,喉返神经和迷走神经,Middle cervical ganglion and sympathetic trunk,中部颈神经节和交感神经干,Anatomy & Physiology解剖学和生理,69,上呼吸道外科手术中英培训ppt课件,70,上呼吸道外科手术中英培训ppt课件,71,Temporary Tracheotomy 4,暂时性气管切开术,4,Surgery,外科手术,Insert small wound retractor,插入小型创口牵开器,Incise ligament between 2 tracheal rings with scalpel blade nr 11 (tube cuff!),用解剖刀片切开两个气管环之间的韧带,Place tag suture,放置标记缝合线,Fixate the segment of trachea that will be resected with musquito forceps,用蚊式钳固定将要切割下来的气管切片,Resect a round part of tracheal cartilage and ligament, suitable for the animals size,在气管软骨和韧带上切下环状部分，适合的动物型号,Temporary Tracheotomy 4暂,72,上呼吸道外科手术中英培训ppt课件,73,上呼吸道外科手术中英培训ppt课件,74,上呼吸道外科手术中英培训ppt课件,75,上呼吸道外科手术中英培训ppt课件,76,上呼吸道外科手术中英培训ppt课件,77,Temporary Tracheotomy 5,暂时性气管切开术,5,Surgery,外科手术,Replace oral tube with a sterile endotracheal tube inserted through the stoma or place canula,用一个无菌的气管内导管代替口管，通过气孔或套管插入,Suture outer canula to the skin and fixate canula to the neck with cotton tape,将套管外层缝合到皮肤上，并用棉带将套管固定到颈部,Temporary Tracheotomy 5暂,78,上呼吸道外科手术中英培训ppt课件,79,上呼吸道外科手术中英培训ppt课件,80,上呼吸道外科手术中英培训ppt课件,81,上呼吸道外科手术中英培训ppt课件,82,Temporary Tracheotomy 6,暂时性气管切开术,6,Aftercare,术后护理,Replace and clean inner canula every 2 hours, more often if indicated,每,2,小时置换或清洗内部的套管，如果需要的话可以增加频率,Tracheal toilet (suction),气管清理（抽吸）,Broadspectrum antibiotics,广谱抗生素,Rest,静养,Well ventilated and humidified room,通风良好和湿润的环境,Temporary Tracheotomy 6暂,83,Temporary Tracheotomy 7,暂时性气管切开术,7,Removal of canula,去除套管,When upper airway is patent again,当上呼吸道重新恢复功能,The tracheotomy wound is NOT sutured, but left to heal by second intention,气管切开术伤口不缝合，让其进行二期愈合,Continue AB until wound has healed,持续,AB,直到伤口恢复,Temporary Tracheotomy 7暂,84,Laser laryngectomy BOS激光喉头切开术,Laser laryngectomy BOS激光喉,85,Laser laryngectomy BOS激光喉头切开术,Laser laryngectomy BOS激光喉,86,BOS-syndrome BOS-,综合征,Brachycephalic dog with dyspnea = BOS,短头颅犬伴有呼吸困难,=BOS,Temperature! Oxygen!,体温、血氧,Radiography and endoscopy,射线检查或内窥镜检查,Determine most abnormal anatomical location and overall prognosis BEFORE surgery!,在手术之前确定异常解剖学部位以及预后,Proper aftercare and client education!,合适的术后护理以及对主人的教育！,BOS-syndrome BOS-综合征Brachycep,87,BOS- Prevention BOS,预防,Breeding program!,育种计划！,Role of veterinarian, specialist, government,兽医、专家和政府的作用,Role of breeders, show judges,育种人的作用、提供判断,Owners!,宠物主人！,BOS- Prevention BOS预防Breedi,88,Questions?,提问时间,Questions? 提问时间,89,