TNR

Question 1

List 4 ligaments found in bitch reproductive system

Answer 1

1. Proper ligament : Connecting ovarian bursa to uterine horn
2. Broad ligament :

• Extending from ovary to uterine horn to uterine body
• Mesometrium
• Needed to be 扎起來

1. Suspensory ligament : Connecting kidney to ovarian bursa, 可以彈鬆/break laterally 以免傷到血管
2. Round ligament : cranial end of the uterine horn within a fold of peritoneum laterally from the broad ligament toward the deep inguinal ring

Question 2

how to find uterine?

Answer 2

1. 從urinary bladder 的dorsal side & descending colon的lateral side找到uterine body –> 沿著cranial side找uterine horn and ovary
2. 沿著腹壁往側面伸進去，找一個比較有彈性的

Question 3

如何防止下刀時傷到內臟？

Answer 3

1. 將linea alba往上提by thumb forceps
2. Horizontally入刀
3. 刀面朝上

Question 4

進去腹腔后會看到什麼組織first? +補充

Answer 4

1. 大網膜greater omentum
2. 往cranial side塞，不要擋住視線
3. 記住做完手術要把它放回去原來的位置
4. 皮下的線可以跟表皮一樣

Question 5

全程只可以提拉著那個地方？

Answer 5

proper ligament

Question 6

結扎的地方 + number of 手術線needed to be prepared

Answer 6

1. Suspensory lig. ovarian a. & v. (left and right) : 4 ligatures in total
2. Uterine body (near cervix) : 2 ligatures in total
3. Broad lig. (left and right) : 2 ligatures in total

Overall: 8 ligatures! 準備8~10條線

Question 7

打ovary結的距離

Answer 7

1. 先打proximal，再打distal
2. Proximal<–0.5cm–>distal<–0.5cm–>切割處<–0.5cm–>ovary

So 第一個結要距離卵巢1.5cm！

Question 8

How to ligate 表皮？Why

Answer 8

Bury knot內縫法

Prevent 傷口外露，尤其是這些都是流浪動物

Question 9

Layers of muscle

Answer 9

1. fascia
2. muscle
3. peritoneum (白線linea alba）

Question 10

剃毛刷洗位置

Answer 10

cranial to xiphoid劍突, caudal to pubis恥骨聯合、左右到體側的中間

Question 11

draping位置

Answer 11

xiphoid to pubis symphysis

Question 12

Incision site

Answer 12

Dog 前1/3
Before estrus 中1/3
深胸犬、大子宮（分娩多次的） 中1/3
Cat 中1/3

Question 13

how to deal with 子宮蓄膿的狗

Answer 13

先用antibiotics清洗殘留的表面，以免發炎

Question 14

Broad ligament的兩種處理方法

Answer 14

1. ligation X 2 on each side
2. 直接電燒起來！方向：cranial and caudal

Question 15

wound closure

Answer 15

1. 腹壁的肌肉: simple continuous **要縫到fascia
2. Subcutaneous tissue: bury knot
3. Cutaneous: bury knots (內縫)
   • 用可吸收的monosyn, 也不會貼opsite (防水透氣貼)，因為不會回來
   • 2&3 can use the same 線

Question 16

how can assistant help to 增加視野

Answer 16

助手：一邊提拉子宮的proper ligament，一邊壓著abdominal wall

Question 17

notes after all ligation completed

Answer 17

Ligation 結束後才一次過切掉

檢查出血，可以稍微放入體內去觀察張力較少時是否也出血

都沒有出血 –> loosen mosquito –> 組織滑回去體內

再次檢查出血

將切開的ovary周圍脂肪切開，看是否完整

把大網膜放回原來的位置

Wound closure

Question 18

檢查出血方法 （for checking ligation properly made or not）

Answer 18

可以稍微放入體內去觀察張力較少時是否也出血

Question 19

ligatures and type of sutures used in ovary and uterine body

Answer 19

ovary: 白線，兩個encircling ligature環狀結

子宮體：打兩個ligatures （環狀*2 or 1八字+1環狀）

Question 20

window made before扎起uterine body

Answer 20

Make a window in the broad ligament adjacent to uterine body at each side

Question 21

window made before扎起卵巢

Answer 21

Make a window in the broad ligament caudal to ovarian pedicle (blood vessels entering and exiting ovary) (outside blood vessel)

Question 22

切開的位置於止血鉗的關係 for卵巢

Answer 22

先用好兩個止血鉗夾住，再切開在兩個hemostats之間，切的時候不要離線結端太近！以防線結鬆開

Proximal hemostat: mosquito hemostat

• 半夾著、以防切斷後residue馬上縮回去身體里

Distal hemostat: Metzenbaum

• 全夾，將ovary and suspensory ligament法分開來

Question 23

切開的位置於止血鉗的關係for uterine body

Answer 23

先用好兩個止血鉗夾住，再切開在兩個hemostats之間，切的時候不要離線結端太近！以防線結鬆開

Proximal hemostat: mosquito hemostat

• 半夾著、以防切斷後residue馬上縮回去身體里

Distal hemostat: hemostat

• 全夾，防止切下后暴血&子宮內的感染病原流到腹腔，造成腹膜炎

另外還要用一隻hemostat或是thrumb forceps夾住子宮本體，避免切開后馬上滑進去abdominal cavity裡面

Question 24

where to ligate the broad ligament?

Answer 24

from the two windows made before

X2