craniotomy

Craniotomy is the operation of piercing the fetal head with a device, expelling the intracranial tissue, reducing the skull tissue, and delivering from the vagina. Treating diseases: Fetal death Indication 1. The first born fetus can not be delivered quickly, or prevent perineal laceration. 2. Fetal hydrocephalus. 3. The breech is born after the stillbirth. Contraindications 1. The anterior and posterior diameter of the pelvic inlet is <5.5cm, and it cannot be delivered through the vagina after wearing the skull. 2. There are signs of uterine rupture of the aura or rupture of the uterus. Surgical procedure 1. Preoperative preparation: disinfect the vulva, spread the towel, catheterize. 2. Vaginal examination: determine the position of the anterior and sagittal sutures, first expose the height, and first perform artificial rupture when the membrane is not ruptured. 3. Fix the fetal head: If the fetal head is floating, the assistant fixes the fetal head by hand at the upper edge of the pubic symphysis. 4. Cut the opening skin: expose the fetal head with a vaginal speculum or a vaginal retractor. Under direct vision, use a rat tooth clamp to clamp the scalp at the anterior or sagittal suture of the fetal head and pull down to fix the fetal head. Cut the scalp next to the clamp 2 to 3 cm. 5. Piercing the fetal head: The principle of wearing the fetal head should be taken closest to the vaginal opening, and the most easily penetrated part is the puncture point. It is thus perpendicular to the cranial cavity, and it is safer to penetrate from the size of the fetal head and the cranial suture. The puncture sites taken by different fetal positions are also different. The craniotomy after the breech position can be inserted along the ankle, the mandible, the upper flap, the cervical vertebra, or the fetus can be abducted to the inner side of the mother thigh. The large occipital bone of the fetus is very close to the vaginal opening, and it is safer to puncture under direct vision. The face of the fetal head can be penetrated through the mouth or eyelids, and the forehead is penetrated through the forehead. If the fetal brain has water, the cranial suture has been widened, and it is easy to penetrate into the water through the cardia or cranial suture. 6. Destruction and discharge of brain tissue: There are three commonly used methods: (1) Craniotomy: The assistant pulls the rat tooth forceps. The surgeon holds the closed cranial cranium in the right hand. Under the cover of the middle finger of the left hand, the selected head puncture point is directly reached, and the cranial cavity is vertically inserted. Check the cranial cranial in the cranial cavity, open the craniod, rotate left and right, destroy the brain tissue and discharge it. (2) Inserting a negative aspiration pipette from a puncture brain to aspirate the brain tissue at a negative pressure of 26.7 to 53.4 kPa (200 to 400 mmhg). (3) Insert a pair of scissors or oval clamp into the puncture brain to agitate and expel the damaged brain tissue. Through the above treatment, the volume of the fetal head is reduced, and the fetus can be discharged with the contraction of the uterus or a part of the craniocerebral cortex at the cranial region with the oval clamp can be slowly pulled out. Individuals who cannot be quickly expelled are given a forceps and pulled out. 7. Clamping the cranium: for the two-leaf forceps, under the guidance of the left palm protection and the middle index finger, the right hand-clamping inner blade of the cranial instrument enters the cranial cavity from the scalp to the skull base, and the convex surface faces the fetal face, and the assistant fixes; Protect and guide with one hand, place the outer leaf on the face of the fetal head, and the concave surface of the outer leaf coincides with the convex surface of the inner leaf. The vaginal examination confirmed that there was no cervical and vaginal wall clamping between the two leaf forceps, closing the forceps handle and tightening the screw. 8. Traction: If the fetal head is higher, the traction is slightly posterior, and the volume of the skull is reduced as the brain is drained. When the fetal head is lowered to the vaginal area, it is pulled horizontally. Traction should not be too fast and too fast to avoid vaginal laceration. 9. Postoperative routine vaginal examination: if there is soft tissue injury repaired in time.

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