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1、General SurgeryCommon types of surgery常见手术类型常见手术类型Abdominal Abdominal 腹部腹部Head & Neck Head & Neck 头头& &颈颈Vascular Vascular 血管血管Mastectomy Mastectomy 乳房切除术乳房切除术Cholecystectomy 胆囊切除术Hiatus hernia repair 疝气修复appendectomy阑尾切除术Abdominal surgery: 腹部手术Abdominal Aortic Aneurysm repair (AAA) 腹部大腹部大动脉瘤修复动脉瘤修复
2、Aortic aneurysm stenting 大动脉瘤支架Abdominal surgery: 腹部手术Pancreatic-duodenectomy Pancreatic-duodenectomy (Whipples)(Whipples) 胰腺切除术胰腺切除术removal of pancreas, bile duct, partial removal of pancreas, bile duct, partial removal of stomach, duodenum removal of stomach, duodenum 胰腺，胆道，部分胰腺，胆道，部分胃部、十二指肠切除胃部、十
3、二指肠切除cancer of the head of pancreas胰头癌Abdominal surgery:腹部手术Cystectomy 膀胱切除术膀胱切除术Colectomy 结肠切除术结肠切除术Abdomino-perineal resection 腹会阴切除术腹会阴切除术removal of colon / rectumremoval of colon / rectum结肠结肠- -直肠切除直肠切除(the patient should be made aware of the (the patient should be made aware of the need to use
4、a colostomy bag) need to use a colostomy bag) 患者应被告知将会运用人工肛门袋患者应被告知将会运用人工肛门袋Abdominal surgery:腹部手术Hysterectomy子宫切除术子宫切除术Werteheims hysterectomytotal abd. hysterectomy, bilateral salpingo total abd. hysterectomy, bilateral salpingo oophorectomy, lymph nodesoophorectomy, lymph nodes腹腔子宫切除术，双边输卵管卵巢切除术，
5、淋巴结腹腔子宫切除术，双边输卵管卵巢切除术，淋巴结Prostatectomy 前列腺切除术前列腺切除术Trans-urethral resection of prostate (TURP)经尿经尿道前列腺切除术道前列腺切除术（经尿道前列腺电切）（经尿道前列腺电切）Laparoscopic surgery 腹腔镜手术Head & Neck surgery 头颈部手术For cancer of the tongue, pharynx, larynx , thyroid carcinama舌、咽、喉癌、甲状腺癌舌、咽、喉癌、甲状腺癌Radical neck dissection 根治性颈部淋巴清扫术
6、根治性颈部淋巴清扫术 removal of cancer, lymph nodes removal of cancer, lymph nodes 肿瘤、淋巴结肿瘤、淋巴结切除切除 tracheostomy care tracheostomy care 气管切开护理气管切开护理甲状腺切除Vascular surgery 血管手术Embolectomy 栓子清除术Vascular surgery 血管手术Percutaneous transluminal angioplasty经皮腔内血管成形术Mastectomy乳房切除术Common incision sites 常用切口位置什么样的手术才什么
7、样的手术才什么样的手术才什么样的手术才是真正成功的手是真正成功的手是真正成功的手是真正成功的手术？术？术？术？手术技术的成功是否手术技术的成功是否手术技术的成功是否手术技术的成功是否是评价手术完全成功是评价手术完全成功是评价手术完全成功是评价手术完全成功的唯一标准？的唯一标准？的唯一标准？的唯一标准？LOREM IPSUM 1、 the patients complete return to full participation in life and the capacity to perform its requisite activities2、avoidance of recurren
8、ce of the problem for which the individuals surgery was indicated3、reduced subsequent doctor and hospital-based care and need for medication4、lifelong health术后并发症术后并发症是导致术后患病和死亡的最主要术后并发症是导致术后患病和死亡的最主要因素。因素。术后并发症Hypoxemia低氧血症Hypercapnia高碳酸血症increased work of breathing呼吸做功增加increased work of the heart
9、心脏做功增加fluid and electrolyte imbalances水电解质不平衡metabolic and blood sugar abnormalities代谢及血糖异常reduced cardiac output心输出量减少术后并发症reduced blood volume血流量减少cardiac dysrhythmias心律失常reduced tissue perfusion and oxygenation组织的灌注和氧合下降anemia贫血pain 疼痛alveolar hypoventilation肺泡的换气不足airway collapse气道塌陷术后并发症atelect
10、asis肺不张physiological shunting生理性分流ventilation and perfusion mismatching通气与血流灌注不匹配impaired mucociliary transport粘液纤毛系统的损害accumulation of mucus and stasis分泌物的潴留pneumonia肺部感染thromboemboli血栓术后并发症pulmonary embolus肺栓塞coagulopathies凝血功能障碍sepsis败血症shock休克multiorgan system failure多器官衰竭引起术后并发症的因素手术因素手术因素麻醉因素麻
11、醉因素疼痛疼痛制动和卧床制动和卧床药物因素药物因素患者因素患者因素其他因素其他因素手术因素type of surgery手术方式surgical procedure手术过程operative incision手术切口position assumed during surgery术中体位麻醉因素duration of anesthesia 麻醉持续时间degree of anesthesia 麻醉的程度type of anesthesia麻醉的方式疼痛制动和卧床药物因素麻醉剂麻醉剂肌松剂肌松剂止痛药止痛药患者因素age年龄年龄sex性别性别smoking history吸烟史吸烟史obesity
12、肥胖肥胖nutritional status营养状况营养状况psychosocial situation心理状况心理状况Othersuse of mechanical ventilation机械通气机械通气fluid loss and drainage体液的丢失和引流体液的丢失和引流Role of the physiotherapist: 物理治疗师的角色物理治疗师的角色Pre-op assessment术前评估术前评估pre-op risk factors:术前风险因素术前风险因素Age 年龄年龄smoking history 吸烟史吸烟史previous history既往史（高血压、糖尿
13、病、呼吸系统疾病、既往史（高血压、糖尿病、呼吸系统疾病、心血管系统疾病）心血管系统疾病）sputum and cough 咳咳&痰痰body weight (obesity) 体重（肥胖）体重（肥胖）cardio-pulmonary fitness (exercise tolerance)心肺适能心肺适能（运动耐力）（运动耐力）pulmonary function testing肺功能测试（肺功能测试（VC、FEV1、MVV)nutrition status营养状况营养状况Pre-op considerations 术前考虑术前考虑Purple目的目的：knowledge of the sur
14、gical procedure 掌握手术流掌握手术流程程prediction of high risk patients 预期高风险患者预期高风险患者Risk assessment (prediction) tool风险评风险评估工具估工具Complications requiring physiotherapy interventions:需要物理治疗干预的并发症LEffect of drugs药物效果药物效果LEffect of pain疼疼痛效果痛效果LEffect of immobility制动制动效果效果LEffect of surgery手术效手术效果果lrespiratory s
15、ystem呼 吸系统 FRC 功能残气量 mucociliary activity粘膜纤维运动 ventilation (pain)通气（痛）lmusculo-skeletal sys.肌肉骨骼系统 muscle length & strength肌肉长度和力量l gastric-motility胃动力lcirculatory system循环系统 blood flow (DVT)血流Pre-op treatment 术前干预Education教育教育：establish rapport / education/ teaching of certain skills 建立关系建立关系/教育教育
16、/传授相关技能传授相关技能Communication 交流交流breathing techniques 呼吸技巧呼吸技巧secretion removal techniques去除分泌物的技巧去除分泌物的技巧Pre-op treatment 术前干预Treatment治疗治疗：Goal directed mobilization目标导向的活动目标导向的活动Frequency as indicated 频率频率：range from 1 to 2 每天每天1至至2次治疗次治疗treatments / day for weeks持续数周持续数周Pre-operative role 术前职责prob
17、lem identification 问题确认问题确认risk prediction 风险评估风险评估establish rapport 建立关系建立关系treatment if necessary 必要的治疗必要的治疗education / advice 教育教育/建议建议Intra-operative consideration 手术期间考虑手术期间考虑type of anaesthesia 麻醉类型麻醉类型duration of anaesthesia 麻醉时间麻醉时间duration of surgery手术时间手术时间haemodynamicchanges during surgic
18、al procedures 手术步骤中血液动力的改变手术步骤中血液动力的改变Post-operative management 术后管理Purple目的目的：improve/maintain ventilation 提高提高/保持通气保持通气improve/maintain lung volume提高提高/保持肺容量保持肺容量improve circulation 提高循环提高循环improve/maintain muscle length, strength, joint range提高提高/保持肌肉长度，力量，关节活动范围保持肌肉长度，力量，关节活动范围optimise mobility
19、优化活动能力优化活动能力Post-operative management 术后管理Positioning 体位管理体位管理pain relief疼痛缓解疼痛缓解(timing, what drug, which route) 时间、药物、路径时间、药物、路径application of appropriate techniques for improvement of lung volume提高肺容量的相关技提高肺容量的相关技巧的应用巧的应用(indications and contra-indications, precautions)适应症和禁忌症预防措施适应症和禁忌症预防措施Post-
20、operative management 术后管理oxygen therapy oxygen therapy 氧气疗法氧气疗法 (FiO2, (FiO2, 吸氧分数吸氧分数humidificationhumidification湿度湿度, delivery system, delivery system传送传送系统系统, monitoring, monitoring监控监控) )application of appropriate exercises application of appropriate exercises (passive / active)(passive / active)相关活动的应用（被动相关活动的应用（被动/ /主动）主动）: :prevent complications 预防并发症预防并发症(e.g. DVT check深静脉血栓检查深静脉血栓检查)maximise cardiopulmonary and musculo-skeletal function 最大提高心肺最大提高心肺和骨骼肌肉功能和骨骼肌肉功能goal directed mobilization goal directed mobilization 目标导向的活动目标导向的活动 drainagedrainage引流引流谢谢！谢谢！
