腹腔镜辅助下母犬卵巢子宫摘除术

母犬卵巢子宫摘除术是临床诊疗中最常见的手术之一,本文介绍使用腹腔镜辅助,配合超声刀对20例母犬进行微创卵巢子宫摘除手术。结果表明:采用腹腔镜辅助进行母犬卵巢子宫摘除术,术中出血少、术中术后疼痛轻微、术后无感染。结论:说明该方法临床应用优势显著。     

猫腹腔镜和开腹卵巢子宫摘除术对动脉血气的影响

通过对比猫腹腔镜卵巢子宫切除术与传统开腹术对血气的影响,为猫腹腔镜卵巢子宫切除术提供理论依据.选取健康母猫12只随机分成两组,分别进行腹腔镜卵巢子宫摘除和开腹卵巢子宫摘除,术前、术中30 min和术后采取股动脉血液2 mL进行血气测定,比较pH、PCO2、PO2值的差异.结果发现,腹腔镜组PCO2在术中30 min时与术前差异显著(P＜0.05),与术后差异极显著(P＜0.01),术后检测PCO2接近正常水平,血氧无明显变化,术前中后无明显差异(P＞0.05),pH值术中略有降低,不造成显著差异;开腹组各项数据均无显著性差异.结论为吸入麻醉条件下,CO2气腹会造成术中的PCO2升高,术后整体可恢复到正常水平,而血氧值一直保持稳定,不会对机体造成不良影响,整体效果较为理想.     

异氟烷联用速眠新Ⅱ对西藏小型猪麻醉效果的观察

为了获得对西藏小型猪安全、高效、稳定的麻醉效果,创造良好的外科手术环境,试验采用肌肉注射速眠新Ⅱ(0.1 mL/kg)行诱导麻醉和吸入异氟烷行维持麻醉的联合麻醉方法对10头行氩氦刀冷冻术的西藏小型猪进行麻醉,观察以速眠新Ⅱ作为诱导麻醉对西藏小型猪的麻醉效果以及异氟烷在手术过程中的使用量、镇痛效果、呼吸频率和心率变化及术后苏醒情况。结果表明:速眠新Ⅱ应用于西藏小型猪可达到诱导麻醉的预期效果,手术过程中异氟烷平均吸入浓度为1.78%,西藏小型猪平均心率为69次/min,平均呼吸频率为19次/min,氧饱和度范围值是95%～100%,麻醉过程中未出现麻醉死亡。说明异氟烷联用速眠新Ⅱ是一种较理想的麻醉方法,可应用于长时间的手术过程。     

山羊腹腔镜卵巢切除手术

应用腹腔镜对10只成年未孕母山羊进行卵巢切除术试验,并于术后10d做第2次腹腔镜手术,以探查腹腔内施术部位愈合情况。结果表明,术后10只山羊的卵巢系膜和输卵管断端愈合良好,套扎线已经被组织包埋,手术部位均未发生粘连。     

犬卵巢子宫摘除术

犬的卵巢子宫摘除术也适应于生理性绝育 ,无年龄限制 ,最好在性成熟之前进行 ;也适应于子宫或卵巢肿瘤、子宫扭转坏死和卵巢源性内分泌紊乱而引起子宫积液或子宫积脓。麻醉与保定846全身麻碎 (纯种犬 0 .0 4～ 0 .0 8ｍｌ/ｋｇ体重 ,杂种犬 0 .1～ 0 .1 5ｍｌ/ｋｇ体重 ) ,仰卧保定。手术方法术部剃毛消毒与术部隔离 ,按常规进行。脐后腹中线切开腹壁 6～ 1 2ｃｍ ,打开腹腔 ,然后用米氏钳钩端朝向左侧腹壁轻轻滑向脊柱 ,钩住子宫角并拉出腹外 ,向前寻找到左侧的卵巢及卵巢悬吊韧带 (卵巢被脂肪组织所包围 ,用手按压有黄豆粒样的感觉 )。在…     

双孔腹腔镜猫卵巢子宫切除术对炎性反应的影响

为了研究双孔腹腔镜猫卵巢子宫切除术对炎性反应的影响,并和开腹卵巢子宫切除术进行对比,为腹腔镜手术的发展提供科学理论依据。方法:术后测定白细胞(WBC)和白细胞介素-6(IL-6)的水平。结果:显示腹腔镜手术组(LOVH)的WBC和IL-6在各时间点均低于开腹手术组(OVH)。结论:双孔腹腔镜猫卵巢子宫切除手术引起的机体炎性反应程度比开腹手术轻,有利于手术后机体的更快恢复。     

犬猫疾病防治技术与技巧（十一）

犬猫卵巢子宫切除术1 适应症 正常母犬母猫的永久性绝育，治疗子宫、卵巢或输卵管感染，子宫、卵巢肿瘤、严重创伤或先天性畸形，卵巢源性内分泌失调，如不孕、皮肤病、乳腺瘤、假孕、慕雄狂等。生理性绝育也可仅切除卵巢，但卵巢子宫一并切除可防止子宫疾病。犬猫绝育以6月龄为宜。2 麻醉 全身麻醉。3 保定 仰卧保定，双侧后肢外展。4 术部 腹中线上，在犬由脐起，在猫由脐后1～2cm起向后做4～10cm长的切口。5 术前准备 常规器械，子宫角拉钩，术部无菌准备。6 术式6．1 腹中线腹壁切开，打开腹腔。6．2 探寻卵巢。左右卵巢和子宫角分别位…     

巴马小型猪在达芬奇机器人手术系统中的麻醉管理

为探讨巴马小型猪在达芬奇机器人微创手术中的麻醉管理策略,以丙泊酚麻醉作诱导,异氟醚维持麻醉的复合麻醉方法对巴马小型猪进行全身麻醉,同时用达芬奇机器人对其分别进行心脏、肺脏、肝脏和胃的微创手术,于术前、术中及术后监测巴马小型猪动脉血气和血流动力学变化。结果各组试验猪均顺利完成手术,手术平均时间(166±34)min,麻醉时间(181±38)min,气胸(气腹)时间(122±33)min,在整个麻醉过程及苏醒过程中,各组试验猪安全平稳,未出现体动表现。由此可见,该麻醉方法可用于达芬奇机器人手术系统,且为人医临床应用中的麻醉管理奠定基础。     

小剂量丙泊酚复合瑞芬太尼在门诊输卵管造影术中的临床应用

目的:评价门诊输卵管造影术中使用丙泊酚复合瑞芬太尼实施麻醉的临床效果及安全性。方法:选择拟行输卵管造影手术患者100例,ASA分级Ⅰ-Ⅱ级,随机分成A、B两组,A组丙泊酚复合瑞芬太尼组(n=50),B组丙泊酚复合芬太尼组(n=50),观察术中意识消失时间、呼吸抑制情况、患者配合程度、丙泊酚用量、苏醒时间及麻醉效果,并记录患者麻醉前、诱导后5min、手术开始后5min、清醒后5min时患者的基本生命体征(平均动脉压MAP、心率HR、呼吸频率RR、脉搏氧饱和度SPO2);结果:A组意识消失时间、苏醒时间、异丙酚用量小于B组(P<0.05);术中患者配合程度麻醉效果A组优于B组(P<0.05);诱导前后心率、呼吸抑制、平均动脉压差异比较,两组间无统计学意义(P>0.05)。结论:小剂量丙泊酚复合瑞芬太尼较小剂量丙泊酚复合芬太尼更适合门诊输卵管造影手术麻醉的需要。     

母猫卵巢切除手术的改进

1 常规方法 将母猫麻醉(846麻醉药0.2 mL/kg体重),仰卧保定,固定四肢于手术台,腹部术部剃毛、消毒,覆盖消毒创巾;从脐孔后沿腹中线切开腹壁3～4 cm,取出两侧子宫角;在卵巢基部(卵巢动静脉的后方),钝性穿过两根手术缝线,分别将卵巢两侧血管全部结扎,然后用剪刀将结扎中间部分包括卵巢全部剪掉,确定无血液透出后,将子宫角送回,关闭腹腔.     

Multicenter, randomized controlled trial of pain-related behaviors following routine neutering in dogs

OBJECTIVE: To evaluate the degree of postoperative pain in dogs undergoing elective castration or ovariohysterectomy (OHE); determine whether an association exists between surgeon experience, incision length, or surgery duration and degree of postoperative pain; and determine whether analgesic treatment decreases expression of postoperative pain behaviors. DESIGN: Randomized controlled clinical trial. ANIMALS: 426 client-owned dogs undergoing OHE or castration. PROCEDURES: Dogs underwent OHE or castration performed by an experienced veterinarian or a fourth-year veterinary student. Dogs were randomly assigned to 1 of 4 treatment groups: no perioperative analgesic treatment (n = 44), preoperative administration of morphine (144), preoperative administration of nalbuphine (119), and postoperative administration of ketoprofen (119). Dogs were evaluated while in the hospital before anesthesia and for 4 hours after surgery and once a day at home for 3 days after surgery. RESULTS: Dogs in all 4 groups had significant increases in overall pain scores after surgery, compared with baseline scores. There were significant differences among groups, with control dogs having significantly higher increases in overall pain scores than dogs in the other groups. Factors that did not influence the frequency or severity of pain-related behaviors included breed, individual hospital, anesthetic induction protocol, surgeon experience, and duration of surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that dogs expressed behaviors suggestive of pain following OHE and castration, that analgesic treatment mitigated the expression of pain-related behaviors, and that surgeon experience and surgery duration did not have any effect on expression of pain-related behaviors.     

Adrenal response to adrenocorticotropic hormone in dogs before and after surgical attenuation of a single congenital portosystemic shunt

BACKGROUND: Dogs with single congenital portosystemic shunts (CPSS) often develop postoperative hypoglycemia and prolonged anesthetic recovery. These abnormalities could be attributable to inadequate adrenal response. However, adequacy of adrenal response after CPSS surgery is unexplored. HYPOTHESIS: Dogs with CPSS have inadequate postoperative adrenal response. ANIMALS: Eight nonoperated, 8 ovariohysterectomy (OHE), and 16 CPSS dogs. METHODS: Consecutive day ACTH stimulation tests were performed on nonoperated healthy dogs, healthy dogs before and after OHE, and CPSS dogs before and after surgery. Adequate response was defined as >50% or >30 ng/mL increase in cortisol after ACTH administration. Blood glucose (BG) was monitored before and after surgery. Prolonged anesthetic recovery and refractory hypoglycemia episodes were recorded. RESULTS: Results of consecutive day ACTH stimulation tests did not vary in normal dogs. Results of preoperative ACTH stimulation tests of CPSS and OHE dogs were not significantly different. Dogs with CPSS had higher postoperative baseline cortisol concentrations (median, 329 ng/mL) than OHE dogs (median, 153 ng/mL). Postoperative cortisol increase after ACTH in CPSS was < or =50% in 10/16 and < or =30 ng/mL in 6/16. After surgery, BG was < or =60 mg/dL in 7/16 CPSS dogs. Cortisol concentrations were not correlated with BG. Two CPSS dogs had refractory hypoglycemia and 4 had delayed recovery; all improved with dexamethasone administration (0.1-0.2 mg/kg/IV). CONCLUSIONS AND CLINICAL IMPORTANCE: Contrary to previous reports, baseline cortisol concentrations in CPSS and healthy dogs are similar. Many CPSS dogs have postoperative hypercortisolemia. Response to ACTH does not correlate with postoperative hypoglycemia or prolonged anesthetic recovery.     

Duration, complications, stress, and pain of open ovariohysterectomy versus a simple method of laparoscopic-assisted ovariohysterectomy in dogs

OBJECTIVE: To describe a simple method of laparoscopic-assisted ovariohysterectomy (LAOHE) and compare duration of surgery, complications, measures of surgical stress, and postoperative pain with open ovariohysterectomy (OHE) in dogs. DESIGN: Randomized, prospective clinical trial. ANIMALS: 20 healthy sexually intact female dogs weighing >10 kg (22 lb). PROCEDURES: Dogs were randomly allocated to receive conventional OHE or LAOHE. Intraoperative complications, anesthetic complications, total anesthesia time, and total surgery time were recorded. Serum cortisol and glucose concentrations, temperature, heart rate, and respiratory rate were measured preoperatively and 1, 2, 4, 6, 12, and 24 hours postoperatively. Pain scores were assigned by a nonblinded observer at 1, 2, 4, 6, 12, and 24 hours postoperatively. Duration of surgery, pain scores, objective measures of surgical stress, anesthetic complications, and surgical complications were compared between OHE and LAOHE. RESULTS: Age, weight, PCV, and duration of surgery did not differ between treatment groups. Nine of 10 dogs in the OHE group required additional pain medication on the basis of pain scores, whereas none of the dogs in the LAOHE group did. Blood glucose concentrations were significantly increased from preoperative concentrations in the OHE group at 1, 2, 4, and 6 hours postoperatively and at 1 hour postoperatively in the LAOHE group. Cortisol concentrations were significantly increased at 1 and 2 hours postoperatively in the OHE group. CONCLUSIONS AND CLINICAL RELEVANCE: LAOHE caused less pain and surgical stress than OHE and may be more appropriate for an outpatient setting.     

In situ coagulation and transection of the ovarian pedicle: An alternative to laparoscopic ovariectomy in juvenile horses

The feasibility of leaving the ovaries within the peritoneal cavity after laparoscopic coagulation and transection of the ovarian pedicle was assessed in the juvenile horse. Elective ovariectomy was performed on 10 quarter horses, aged 4 to 5 mo, with the fillies in a Trendelenburg position. The mesovarium was isolated, and multiple coagulation and transection cycles were performed until all ovarian attachments had been severed. The ovaries were dropped within the abdomen, and hemostasis of the transected mesovarium was evaluated before closure. The mean surgical time was 33 min (range, 23 to 48 min). Ten weeks after surgery the fillies were humanely euthanized. At postmortem examination, the ovary location within the abdomen was noted. In 1 horse, there was an abdominal adhesion; viscera had been punctured during insufflation. Of the 20 ovaries, 4 were free-floating within the abdominal cavity; the other 16 were enveloped in the free portion of the greater omentum in the cranioventral abdomen. Histologic examination of the ovaries was performed to assess follicle cell viability. In both the free-floating and the attached ovaries, the deep blood vessels and all examined follicular structures were necrotic and partially mineralized. Laparoscopic electrosurgical transection of the ovarian pedicle without removal of the ovaries should be considered an alternative to other ovariectomy techniques that may be performed in young female horses.     

Hemangiosarcoma in the cat: retrospective evaluation of 31 surgical cases

Hemangiosarcoma was diagnosed in 31 cats. Diagnosis was confirmed by surgical biopsy. Locations of the primary tumors were the abdominal cavity (15 cats), sc tissue (13 cats), thoracic cavity (2 cats), and nasal cavity (1 cat). Nine (60%) of the 15 cats with abdominal hemangiosarcoma had extrathoracic evidence of metastasis: this was not found in the other cats. Of the cats with tumors located in the sc tissue, 6 of 10 (60%) evaluated on a long-term basis had local recurrence of the tumor. Eleven cats were not available for follow-up evaluation, 3 cats were euthanatized at the time of surgery, and 2 others were euthanatized within the first postoperative week subsequent to histologic diagnosis of hemangiosarcoma. Of the remaining 15 cats, 4 with abdominal hemangiosarcoma and 5 with hemangiosarcoma of the sc tissue died at means of 22 and 44 weeks, respectively.     

Laparoscopic ovariohysterectomy in nine dogs

Minimally invasive surgery has been found in humans to reduce pain, incidence of infections, and duration of hospitalization. Minimally invasive procedures are also being described in veterinary medicine. Laparoscopic ovariohysterectomy (OHE) was performed on nine, healthy, intact female dogs using a Harmonic scalpel. Creatine kinase values were determined both before and 12 hours following the laparoscopic OHE; the magnitude of the difference between preoperative and postoperative creatine kinase values did not correlate with length of operative time, length of incisions, or amount of hemorrhage. Complications included one dog that had an omental herniation that was primarily repaired and one dog with seroma formation. Median surgical time for all dogs was 60 minutes (range, 35 to 100 minutes).     

Prognostic factors associated with survival two years after surgery in dogs with malignant mammary tumors: 79 cases (1998-2002)

OBJECTIVE: To identify prognostic factors for female dogs that have undergone surgical removal of malignant mammary tumors. DESIGN: Retrospective case series. ANIMALS: 79 female dogs with malignant mammary tumors. PROCEDURE: Information obtained from the medical records included breed, age, sex, tumor size (maximum diameter), number and location of affected mammary glands, time between tumor identification and surgical removal, radiographic evidence of distant metastasis, surgical procedure, ovariohysterectomy (OHE) status, histologic classification of the tumor, and survival time. RESULTS: Results of univariate analyses indicated that clinical stage, tumor size, OHE status, metastasis to adjacent lymph nodes or distant sites, and histologic classification of the tumor were significantly associated with survival 2 years after surgery. Tumors > or = 5 cm in diameter and tumors that had been identified > 6 months before surgery were more likely to metastasize to adjacent lymph nodes. Ovariohysterectomy was more beneficial in dogs with complex carcinomas than in dogs with simple carcinomas. In multivariate analyses, clinical stage, tumor size, and OHE status were significantly associated with survival 2 years after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that tumor stage, tumor size, and OHE status were significant prognostic factors associated with survival 2 years after surgery in dogs with malignant mammary tumors. Further, either dogs with tumors > or = 5 cm in diameter or dogs with tumors present for > 6 months prior to surgery had a higher risk of having lymph node metastases.     

A huge ovarian cyst in a hysterectomized bitch

A 11-year-old, spayed, female mixed breed-dog was presented with an abdominal mass that was detected 1 month ago. Upon abdominal palpation a large, firm, oval shaped, movable mass was found in the mid-abdominal region. Survey radiograph of the abdomen demonstrated an oval soft tissue dense mass located on the right side of the abdominal cavity. A large, heteregenous and cystic mass with solid components occupying the majority of the abdomen and a small, cystic mass with solid components caudal to the left kidney were identified by transabdominal ultrasonography. Computed tomography scans revealed bilateral ovarian masses, and a small volume of retroperitoneal fluid on the right side. A cystic, but otherwise solid mass located in the right ovary and small retained left ovary encapsulated in the ovarian bursa were excised surgically by midline laparotomy. Histopathological examination of the excised mass from the right side revealed a large cystic structure consistent with an ovarian cyst and multiple corpora lutea and follicles at different maturational stages were detected in the left ovary. The precise origin of the ovarian cyst could not be determined by morphological appearance. Immunohistochemical staining suggested a cyst of surface epithelial origin. At re-examination 6 months after the surgery, the bitch appeared healthy and the clinical findings were all normal. To our knowledge, the cyst described here is the largest reported in an incompletely ovariohysterectomized bitch.     

Comparison of preoperative carprofen and postoperative butorphanol as postsurgical analgesics in cats undergoing ovariohysterectomy

OBJECTIVE: To compare carprofen to butorphanol, with regard to postsurgical analgesic effects, duration of analgesia, and adverse side effects. STUDY DESIGN: Blinded, randomized clinical study. ANIMALS: Seventy-one cats, 0.5-5 years of age, weighing 3.24 +/- 0.61 kg, undergoing ovariohysterectomy (OHE). METHODS: Cats were premedicated with subcutaneous atropine (0.04 mg kg(-1)), acepromazine (0.02 mg kg(-1)), and ketamine (5 mg kg(-1)). Anesthesia was induced with ketamine (5 mg kg(-1)) and diazepam (0.25 mg kg(-1)) given intravenously, and maintained with isoflurane. There were three treatment groups: group C (4 mg kg(-1) carprofen SC at induction), group B (0.4 mg kg(-1) butorphanol SC at end of surgery), and group S (0.08 mL kg(-1) of sterile saline SC at induction and end of surgery). Behavioral data were collected using a composite pain scale (CPS), prior to surgery (baseline) and 1, 2, 3, 4, 8, 12, 16, 20, and 24 hours post-surgery. Interaction scores were analyzed separately. Cats with CPS scores >12 received rescue analgesia (meperidine, 4 mg kg(-1), intramuscular). RESULTS: Sixty cats completed the study. The CPS scores did not differ significantly between groups C and B at any time period. CPS scores for groups B and C were significantly increased for 12 hours post-surgery, and in group S for 20 hours. Both group C and B CPS scores were significantly lower than group S in this 20-hour postoperative period, except at 4 hours (B and C) and at 3 and 8 hours (B alone). Interaction scores for group C returned to preoperative baseline 4 hours after surgery, while both groups B and S remained increased for at least 24 hours post-surgery. Nine cats required meperidine. CONCLUSION: In this study, carprofen provided better postsurgical analgesia than butorphanol. Clinical relevance Neither drug completely abolished pain, however preoperative carprofen provided better pain control compared with postoperative butorphanol in the 24-hour period following OHE surgery in cats.     

Enteral hyperalimentation administered via needle catheter-jejunostoma as an adjunct to cranial abdominal surgery in dogs and cats

Ten dogs and 2 cats that underwent extensive cranial abdominal surgery were nutritionally maintained after surgery by enteral hyperalimentation administered via needle catheter-jejunostoma for an average of 8 days after surgery. Nine of the 12 patients survived the immediate postoperative period.