二十、眼部手术

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1、三、眼部手术（一）眼睑内翻矫正术【适应症】下眼睑内翻。【保定和麻醉】俯卧保定，全身麻醉或浸润麻醉。BlepharospasmInturningExcoriationPurulentdischargeSecondaryuveitisandhypopyoniflesionissevereSevereconjunctivitisedemaulcerationblepharospasmMiosis（especiallyifthecorneaisulcerated）epiphoraepiphoraDermishydratedinturning用镊子距睑缘2~4mm提起皮肤，并用直止血钳或弯止血钳将其夹住

2、【术式】钳夹长度与内翻睑缘相等，宽度依内翻程度而定(钳夹时眼睑应有一定程度的外翻)。用力钳压皮肤或用持针钳钳压止血钳，使去除止血钳后皮肤仍皱起沿止血钳压痕将其剪除皮肤切口呈月牙形或椭圆形用4号丝线结节缝合皮肤创缘。缝合要密，保持针距2mm。【术后护理】患眼涂布或滴入抗生素眼膏或抗生素眼药水，3~4次/d。颈部安装颈圈，防止自我损伤病眼。术后10~14d拆线。术后数日局部肿胀可逐渐减轻（二）眼睑外翻矫正术【适应症】下眼睑外翻。【保定和麻醉】俯卧保定，全麻或浸润麻醉【术式一】outturningOutturnedlidepiphoraConjunctivalcongestionandinflamm

3、ation距睑外翻下缘2~3mm处切一“V”形切口从其尖端向上分离皮瓣，用镊子将皮瓣提起，再用剪刀钝性分离“V”形皮肤切口周围皮下组织从尖端向上作“Y”形缝合。边缝合边向上移动皮瓣，直至外翻矫正为止。矫正后的下眼睑【术式二】ThelidmarginismarkedlaterallyModifiedprocedureAnestimateoftheamountofmargintoberemovedismade，andthelidismarked.Theventralendofthetriangleismarked10to14mmbelow.Thefirstincisionismadewithstr

4、aightMayoscissorsThesecondincisionismadeThetriangularpieceisremoved.Notethattheconjunctivaldefectissmaller，justifyingonelayerofsuturesintheskininsomecases.Thewoundsuturedwith6~0silk.【术后护理】患眼涂布或滴入抗生素眼膏或抗生素眼药水，3~4次/d。颈部安装颈圈，防止自我损伤病眼术后10~14d拆线。术后数日内局部肿胀可逐渐减轻（三）第三眼睑腺摘除和复位术【适应症】第三眼睑腺脱出（樱桃眼）【保定和麻醉】侧卧或胸侧卧保

5、定。全身麻醉，先以噻胺酮复合麻醉剂做浅麻醉，再以加有青霉素液的注射用水(每l0ml加青霉素10万IU)冲洗眼结膜，然后滴入加有肾上腺素的局部麻醉剂。【局部解剖】位于瞬膜的前下方，被覆脂肪组织。腺体组织分泌的液体经多个导管抵至球结膜表面，提供大约30％的水性泪膜。具有保护角膜、除去角膜上异物、分泌和驱散角膜泪膜及免疫等功能。有作者认为不宜切除第三眼睑腺(除非组织学证实为恶性肿瘤或严重损伤)，易引起角膜结膜炎和干性角膜结膜炎。【术式】1.用组织钳夹住增生物包膜外引使充分暴露。2.以小型弯止血钳钳夹蒂部3.以剪刀或外科刀剪除或切除4.尽量不损伤结膜及瞬膜，用青霉素液冲洗创口，3~5min后去除夹钳，

6、灭菌干棉球压迫局部止血。也可剪除增生物后立即烧烙止血，但要用湿灭菌纱布保护眼球，以免灼伤。5.以青霉素40万IU肌注抗感染。术后也可用新霉素眼药水点眼2~3d。（四）ExcisionofEyelidTumorsEyelidtumorsarecommoninthedog.Thetarsalglandadenomaisthemostfrequentlydiagnosedeyelidtumorinthedog.Lesscommonlyfoundareadenocarcinomas,melanomas，andpapillomas.Thetarsalglandadenoma,aswithmosttumo

7、rsofthecanineeyelid,isclinicallybenign,andsurgicalexcisionisusuallycurative.Cryosurgeryusing1iquidnitrogenat-20℃canalsobeusedtotreatthesetumors.【surgicalmethod】Astheconjunctivaisnotinvolved,itisnotrem