站立牛的剖腹产术

1、站立牛的剖腹产术Caesarian Section on the Standing CowPrepared by: Dr. Terry Hunt傅小平博士征 兆 Indications胎儿不能顺产Unable to deliver a live calf by vaginal deliver犊牛相对于母牛骨盆过大Over-sized calf for the pelvic size of the dam不能纠正胎位不正Unable to correct mal-presentation of fetus per-vagina胎儿异常或畸形Fetal monster or abnormality

2、准备Preparation手术位置在左侧坎窝The site is the left para-lumbar fossa of the cow剃毛时应该从背侧到肋骨末端，切口前面是最后一个肋骨，后面为股骨The hair should be removed from the dorsal midline to the flank fold. The anterior landmark is last rib and the posterior landmark is the stifle剃毛后，再麻醉，同时要用淡碘酒溶液消毒两遍After hair removal, a double scru

3、b procedure is done then after anesthesia, the skin is again scrubbed twice and the skin is painted with a tamed iodine solution麻醉Anesthesia硬膜外腔麻醉3ml Epidural 3ml椎旁神经T 17, L 1, L 2 & L 3 Para-vertebral or modified Paravertebral - T 17, L 1, L 2 & L 3外科程序Surgical Procedure 切口位置在左侧坎窝，皮肤切口长30cm左右Celiot

4、omy incision in left para-lumbar fossa about 30 cm in length接着分别切开外斜肌、内斜肌、横肌、腹膜Incise trough external abdominal oblique muscle then grid through internal oblique, transverse oblique and peritoneum剖腹后，直到将子宫取出再切开The uterus is not incised until it can be exteriorized through the celiotomy incision site

5、如果胎儿再左侧子宫，可抓住子宫内胎儿直接送到切口位置If the calf is in the left horn, grasp the uterus over the cannon bone of the calf and draw uterus to incision site. 如果胎儿在右侧子宫，那么胎儿和子宫都需要旋转位置（以便小牛接近子宫切口位置）If the calf is in the right horn, the calf and uterus must be rotated (the back of the calf will be closest to the inci

6、sion site)通过挤压胎儿后背所产生的压力旋转子宫（子宫体中应该保持右侧的压力高）Rotate the uterus and calf by applying rocking pressure on the back of the calf (the pressure should be applied high to rotate the right horn under the body of the uterus)一旦子宫体旋转好后，要紧紧抓住胎儿胫骨移到切口位置Once the uterus has been rotated, grasp the uterus over the

7、cannon bone of the calf and draw uterus to incision site.如果胎儿位置仍是腿在前应该将其头部移至子宫切口位置进行前面同样的程序If calf is in posterior position, the same procedure is carried out to bring the uterus/cannon bone and head to the incision site.手术中将腹腔内容物(肠等)远离切口是很重要的It is important to keep intestines back from the incision

8、 site.切开子宫时胎儿的腿到达子宫角时应该避免卵巢及其相关的组织The leg of the calf will be in the horn of the uterus so incise the uterus over the cannon bone of the calf avoiding the ovary and related structures.这切口的长度应该有胎儿腓关节到蹄趾间长The incision should be the length of the calfs leg from the hock to the tip of the hoof如果头在切口位置应用

9、同样的方法将头取出If the head is at the incision site use the same technique but then exteriorize the head of the calf如果切口不够大应该及时将切口增大If the incision is not long enough in the body wall, extend it at this time助产绳应该系紧胎儿牛的脚同时沿着母牛反方向用力Chains/straps should be placed around the feet of the calf and the calf shoul

10、d be pulled out towards the back of the cow助手应该配合助产An assistant should deliver the calf如果犊牛前后端同时出现，那么就比较困难将其从子宫切口拉出，此时可以用你的手去摸犊牛臀部If the front end is presented, sometimes it is difficult to get the hips of the calf through the incision site- guide the hips with your hand一旦胎儿取出接下来的工作主要由助手完成Once the c

11、alf has been delivered, it is the responsibility of the assistant从子宫内移去胎盘和液体Remove excessive placenta and fluid from the uterus 用3号羊肠线进行子宫两层缝合Utilize a two-layer closure technique to close the uterus using # 3 catgut suture material两层应用连续倒置缝合法Both layers should use a continuous inverting pattern第一层缝

12、合应该用伦伯特氏缝合First layer should be closed using the Utrecht or Lambert pattern接着用康乃尔缝合法This should be over sewn using a Connell pattern检查密封性并将子宫送至原来位置，检查有无撕裂处Check for leakage then return the uterus to is normal position in the abdomen (check for tears)腹膜连续缝合以及横肌缝合Close the peritoneum and transverses m

13、uscle layer in one continuous pattern内斜肌连续缝合Close the grid of the internal oblique with a continuous pattern外斜肌连续缝合Close the external oblique muscle with a continuous pattern 用3号不可以吸收缝线间断十字交叉皮肤缝合Close the skin using # 3 non-absorbable interrupted cruciate pattern接着Follow up广谱抗生素连用3天Broad-spectrum antibiotics for three days皮肤缝合3-4周拆线Remove