本课程为PGY-3住院医师提供了普外科各方面解剖学基础的坚实基础. 通过10个连续实验室, 每个都关注解剖学的不同方面, 住院医师将获得深入的解剖学知识, 曝光技术, 以及普通外科医生所需要的技能.

实验一:皮肤、切口、伤口闭合和皮瓣

实验室1

Correct use of surgical instruments; relaxed skin tension lines and incision placement; superficial body layers (skin, 皮下的丛, subcutaneous fat); wound closure, 缝合线, and staples; undermining and skin flaps (rotation flap, 推进皮瓣, Z-plasty); maybe vascular and bowel anastomoses.

 

 
实验室2:普通外科医生的肢体

实验室2

浅层(静脉通路部位), local anesthesia); limb organization, compartments and deep neurovascular structures; limb arterial access, 常见血管闭塞部位, and limb vascular bypass grafts (maybe femoral-popliteal bypass); limb fasciocutaneous, 肌皮瓣和骨肌皮瓣及蒂(可能是前臂桡骨皮瓣和腓骨皮瓣).

 

实验室三:乳房、胸壁、腹壁和疝气

lumpectomy_200x150

Breast anatomy; anatomy of breast surgeries (lumpectomy and various mastectomies); breast lymphatic drainage; axillary anatomy, 第1层的解剖,2,3 axillary nodes; anatomic basis of breast cancer staging; thoracic wall layers and 神经与血管的供应 pattern; abdominal wall layers and 神经与血管的供应 pattern; abdominal wall hernia sites; anatomical consequences of abdominal incision, 套针, and port placement; internal surface of abdominal wall (including triangle of doom, triangle of pain); inguinal canal, 精索, 和腹股沟疝修补术(TEP), TTAP, 和开放式维修), 股三角, 以及股疝修补术. 如果时间允许,可以进行TRAM或DIEP皮瓣乳房重建.

 

实验室4:外侧入路胸腔

胸部

Review embryology of respiratory and thoracoabdominal diaphragm development; anatomical considerations in thoracentesis and chest tube placement, right lateral thoracotomy incision and very large non-surgical extension for access to thoracic cavity; exploration of pleural space, 粘连的溶解, identification of pleural regions and pulmonary ligament; identification of lung lobes, 裂缝, and lung root structures; lung resections (segmentectomy, 叶切除术, pneumonectomy); diaphragm, 膈神经, and diaphragmatic hernia sites; mediastinal structures accessible through right lateral thoracotomy. 重复开胸手术和左侧手术.

 

实验室5:前路胸腔入路

肺网图像

Pericardiocentesis; pericardiotomy through left lateral thoracotomy; disarticulation of acromioclavicular joints, detachment of sternopericardial ligaments and elevation of anterior chest wall; exploration of pericardium and pericardial sinuses; venous plane of mediastinum and subclavian central line placement; arterial plane of mediastinum and cardiopulmonary nerve plexuses; removal of heart and exploration of superior and posterior mediastinum (trachea, 支气管, 纵隔节点站, anatomic basis of lung cancer staging; esophagus, 胸导管, 交感神经干, 奇静脉, 迷走神经和喉返支, 胸主动脉). 心脏解剖,如果有用,并回顾先天性心脏异常.

 

 

实验6:腹膜内盆腔脏器原位及腹膜内脏器的动员

throacic

消化系统胚胎学综述, 肠系膜, and blood supply; 粘连的溶解, 腹膜区识别, 空间, and gutters; identification of abdominopelvic organs in situ; ventral mobilization of right colon, 左结肠腹侧移位, Kocher maneuver; identification of abdominal aorta, 腹腔轴, 肠系膜上动脉, inferior mesenteric artery and associated autonomic nerve plexuses; identification of all arterial branches and all anastomoses to GI tract; identification of portal vein and all tributaries; identification of portal-caval anastomosis sites; position of common variations in arterial supply and venous drainage; mesenteric and preaortic lymph nodes.

 

实验室7:腹部器官的切除、吻合和移植

实验室7

Identification of hepatogastric and hepatoduodenal ligaments and contents; gall bladder, 胆管, 卡洛特三角形, 3点和9点的总胆管动脉, cholecystectomy; liver, 外科叶, 奎诺段, 肝内门静脉, 肝静脉, 肝切除术, liver transplantation; stomach, 血液供应和胃切除?; pancreas, 胰腺血供, 钩突和上肠系膜血管, pancreatectomies; spleen, 脾血管, and splenectomy; small bowel resections, 吻合和重新排列, (Roux-en-Y and gastric bypass; Whipple procedure); anatomic bases of liver, 胆囊, 胃肠道肿瘤分期及肝、脾损伤分级.

 

实验室8:腹膜外腹腔及盆腔脏器

lab8

肾(Gerota筋膜), 肾脏基本解剖, 神经与血管的供应, 肾与肾盏和盆骨一分为二, renal injury grades); ureter (abdominopelvic course, 血液供应), adrenal glands and blood supply; aorta, 分支成对的腹盂器官, AAA repair and anatomic indications; inferior vena cava and tributaries from paired abdominopelvic organs and trunk wall, caval-caval anastomoses; para-aortic lymph nodes and anatomic basis of renal and adrenal cancer staging; posterior abdominal wall muscles.

 

实验室9:结肠、直肠、骨盆和会阴

Lab9

结肠切除术(右半结肠切除术), 扩大右半结肠切除术, 横结肠节段性切除, 左部分结肠切除术, 扩展左结肠切除术, 乙状结肠切除, total colectomy); rectum, 直肠系膜, presacral空间, and lymphatic drainage; rectal resections (LAR, APR and colostomy); prepubic space and extraperitoneal approach to pelvic viscera (bladder, pelvic urethra; prostate, 输精管和精囊或卵巢, 子宫管, uterus and vagina; pelvic floor; male and female perineum.

 

实验室10:普通外科头颈科

头部和颈部

头颈部血管解剖(颈动脉鞘), 颈动脉, 颈动脉内膜切除手术, 颈内静脉, IJ central line placement); larynx (laryngeal 神经与血管的供应, cricothyroidotomy); thyroid and parathyroid glands (vascular supply, 甲状腺切除术, para甲状腺切除术); tracheostomy; pharynx and retro咽 space; anatomy basic to nasogastric intubation and orotracheal intubation (oral, 咽, 以及喉轴和“嗅位”).