腹腔镜手术麻醉.pptVIP

SurgeonUrologistGynecologistDiagnosticIntestinalHerniotomyLiverSpleenFundioplicationCholecystectomyEsophagusAxillarlymphonodesGastricbandingAdrenalectomyParathyreoidectomyDiagnosticNephrectomyKidneycystsProstatectomyVaricoceleLymphadenectomyTesticulardescensusDiagnosticTubarligationAdnexectomyOvarectomyLymphadenectomyEndometriosisMyomectomyAxillarlymphonodes对麻醉的要求与挑战气腹气肿气胸气体栓塞对通气的改变高碳酸血症对血流动力学的反应局部血流动力学的影响心率失常反流误吸肩部酸痛对肺功能影响OrganSystemPhysiologicEffectPotentialOutcomePulmonary?peakairwaypressure?pulmcomplianceSuperiordisplacementofdiaphragm?end-tidalCO2Barotrauma?pCO2or?pO2?pCO2or?pO2Acidosis对心血管功能影响OrganSystemPhysiologicEffectPotentialOutcomeCirculatoryDirecteffects-?CVP,CWP,SVR(afterload),MAPIndirecteffects–arteriolardilationandmyocardialdepressionIndirecteffects–sympathetics,renin-angiotensin?cardiacwork?bloodpressure?Bloodpressureandcardiacoutput?Urineoutput?*Inourhospital,laparscopicabdominalsurgeryonalargerscalewasintroducedinthenienties.Alreadyin1991onlyhalfofthecholecytectomieswereperformedthroughanopenaccess,whileoverthefollowing5yearsthisportiondecreasedto33%,finallyendingupatonly13%in2002.****Thelistofinterventionsthatcanbeperformedviaendoscopyhasbeengrosslyexpanded.Thisisduetocountinuousadditionofvisceralsurgical,urologicalandgynecologicalinterventionsthataredevelopedandaccreditedtobefeasibleforthiskindofproceeding.移植外科微创外科修复外科肿瘤的分子生物学治疗一、腔镜手术的发展背景伟大思想的提出-----公元前460-377提出借助某种手段窥视和检查直肠病变Hippocrates1795年德国PhilipBozzini开创了诊断与治疗的新天地现代腹腔镜的起源1901年，德国的外科医师Georgkelling在狗的腹腔内插入一根膀胱镜,并用空气制造气腹进行检查，这为腹腔镜的起源。Georgkelling单击此处添加大标题内容HansChristianJacobaeus(1879–1937)1910年瑞典斯德歌尔摩的jacobaeus首次在临床使用腹腔镜和胸腔镜检查，并将其定义为Laparoscopy。Hepublishedhisreportin《MünchenerMedizinischeWochenschrift.》logo1911年美国johnshopkins医院的外科医师bernhein经腹壁的